There are no studies of mineralocorticoid receptor antagonist ( MRA ) treatment examining outcome in unselected real-life patients with myocardial infarction and heart failure.
There is uncertainty regarding effects of MRA in relation to left ventricular ejection fraction ( LVEF ) and chronic kidney disease ( CKD ).
The aim was to assess MRA use and compare outcomes in myocardial infarction patients with heart failure in relation to left ventricular ejection fraction and chronic kidney disease.
Patients with myocardial infarction and heart failure registered in the Swedish myocardial infarction registry, SWEDEHEART, 2005-2014, were included.
Associations between MRA use and all-cause mortality up to 3 years were assessed with multivariable Cox regression, stratified by EF groups and presence of chronic kidney disease ( estimated glomerular filtration rate <60 mL/min per 1.73 m2 ).
Of 45 071 patients with myocardial infarction and heart failure, 4470 ( 9.9% ) received MRA.
Those with heart failure and LVEF less than 40% more often had MRA ( 19.6% ) compared with those with LVEF 40% to 49% ( 9.1%) or LVEF greater than or equal to 50% ( 4.7% ).
8.6% of patients with chronic kidney disease received MRA.
After adjustment, MRA use was associated with lower mortality in those with LVEF less than 40% ( hazard ratio [ 95% confidence interval ] 0.81 [ 0.75-0.88 ] ) and LVEF 40% to 49% ( 0.88 [ 0.75-1.03 ] ) but not in those with LVEF greater than or equal to 50% ( 1.29 [ 1.09-1.53 ] ), with significant interaction between MRA and LVEF ( P less than 0.0001 ).
The association between MRA use and mortality was similar in those without ( 0.96 [ 0.88-1.05 ] ) and with ( 0.92 [ 0.85-0.99 ] ) chronic kidney disease.
In conclusion, in patients with myocardial infarction and heart failure, MRA use was associated with better long-term survival in patients with LVEF less than 40% but not in those with LVEF greater than or equal to 50%, while the mortality risk was similar in MRA-treated patients with or without chronic kidney disease. ( Xagena )
Löfman I et al, J Am Heart Assoc 2018 Jul 6;7(14). pii: e009359. doi: 10.1161/JAHA.118.009359.