Mineralocorticoid Receptor Antagonism in  Acute Myocardial Infarction Who Benefits?

Beygui et al.(1) deserve credit for demonstrating, through the ALBATROSS (Aldosterone Lethal Effects Blockade in Acute Myocardial Infarction Treated With or Without Reperfusion to Improve Outcome and Survival at Six Months Follow-up) study, that the beneficial effects on cardiovascular outcomes of mineralocorticoid receptor antagonism (MRA) after myocardial infarction (MI) do not extend to patients with preserved left ventricular function and largely without heart failure. This result may seem unsurprising when the baseline left ventricular ejection fraction (LVEF) of patients in ALBATROSS (50% [45 to 60]) is taken into account, as MRA putatively exerts many of its cardioprotective effects through attenuation of remodeling in the post-MI setting (and in chronic heart failure). Patients with relatively preserved LVEF at baseline might not be expected to remodel adversely (hence the failure of MRA to improve outcome in this population). However, clinical studies have failed to demonstrate a consistent beneficial effect of MRA on adverse remodeling in both MI and chronic heart failure.
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research