Titre :

Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction

Auteur(s) :

Beygui, Farzin [Auteur]
Physiopathologie et Stratégies d'Imagerie du Remodelage cardiovasculaire [PSIR]
CHU Caen
Groupe Action
Van Belle, Eric [Auteur]
Institut Coeur Poumon [CHU Lille]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Ecollan, Patrick [Auteur]
CHU Pitié-Salpêtrière [AP-HP]
Groupe Action
Machecourt, Jacques [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Hamm, Christian [Auteur]
Lopez de Sa, Esteban [Auteur]
La Paz University Hospital
Flather, Marcus [Auteur]
University of East Anglia [Norwich] [UEA]
Verheugt, Freek [Auteur]
Vicaut, Eric [Auteur]
Hôpital Lariboisière-Fernand-Widal [APHP]
Groupe Action
Zannad, Faiez [Auteur]
Centre Hospitalier Régional Universitaire de Nancy [CHRU Nancy]
Centre d'investigation clinique [Nancy] [CIC]
Pitt, Bertram [Auteur]
Children's Hospital of Michigan
Montalescot, Gilles [Auteur]
Groupe Action
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [ICAN]
Institut de cardiologie [CHU Pitié-Salpêtrière]

Titre de la revue :

Heart

Pagination :

1843-1849

Éditeur :

BMJ Publishing Group

Date de publication :

2018-04-25

ISSN :

1355-6037

Mot(s)-clé(s) en anglais :

acute myocardial infarction

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

BackgroundTwo recent randomized trials studied the benefit of Mineralocorticoid receptor antagonists (MRA) in ST-elevation myocardial infarction (STEMI) irrespective or in absence of heart failure. The studies were both ...
Lire la suite >BackgroundTwo recent randomized trials studied the benefit of Mineralocorticoid receptor antagonists (MRA) in ST-elevation myocardial infarction (STEMI) irrespective or in absence of heart failure. The studies were both undersized to assess hard clinical endpoints. A pooled analysis was pre-planned by the steering committees.MethodsWe conducted a pre-specified meta-analysis of patient-level data of STEMI patients recruited in 2 multicenter superiority trials, randomized within 72 hours after symptom onset. Patients were allocated (1:1) to 2 MRA regimens: 1. An intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg od) versus standard therapy; or 2. Oral Eplerenone (25 to 50 mg) in versus placebo. The primary and key secondary outcomes, all cause death and the composite of all cause death or resuscitated sudden death respectively, were assessed in the intention to treat population using a Cox model stratified on the study identifier.ResultsPatients were randomly assigned to receive (n=1118) or not the MRA regimen (n=1123). After a median follow-up time of 188 days, the primary and secondary outcomes occurred in 5(0.4%) and 17 (1.5%) patients (adjHR 0.31, 95%CI 0.11 to 0.86, p=0.03) and, 6(0.5%) and 22(2%) patients (adjHR 0.26; 95% CI 0.10-0.65, p=0.004) in the MRA and control groups respectively. There were also trends toward lower rates of cardiovascular death (p=0.06) andventricular fibrillation (p=0.08) in the MRA group. ConclusionOur analysis suggests that compared to standard therapy MRA regimens are associated with a reduction of death and death or resuscitated sudden death in STEMI.Lire moins >

Langue :

Anglais

Comité de lecture :

Oui

Audience :

Internationale

Vulgarisation :

Non

Collections :

• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Source :

Harvested from HAL