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Mineralocorticoid receptor antagonists after acute myocardial infarction in patients with mildly reduced left ventricular ejection fraction
Session:
Posters (Sessão 5 - Écran 4) - Síndromes Coronárias Agudas - tratamento farmacológico
Speaker:
Catarina Ribeiro Carvalho
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Catarina Ribeiro Carvalho; Pedro Rocha Carvalho; Marta Catarina Bernardo; Isabel Martins Moreira; Fernando Fonseca Gonçalves; Pedro Mateus; Ana Baptista; Ilídio Moreira; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> mineralocorticoid receptor antagonists (MRA) are recommended after acute myocardial infarction (AMI) in patients with left ventricular ejection fraction (LVEF) ≤40% and heart failure or diabetes, aiming to reduce morbidity and mortality. However, some studies showed MRA prognostic benefit also in patients with heart failure and mildly reduced LVEF, which has not been properly addressed after an acute coronary syndrome (ACS).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> to evaluate and compare the prognostic impact of MRA therapy after ACS in patients with mild LVEF dysfunction.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> this was a national multicentre retrospective study that included patients with ACS and LVEF of 40 to 50%<span style="color:black">, between 2010 and 2021</span>. Patients previously taking MRA and with previous history of heart failure or chronic kidney disease were excluded. The impact of MRA prescription on the outcomes of in-hospital mortality, one year mortality and cardiovascular re-admission was evaluated.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>a total of 5291 patients were included, 13.6% with initiation of MRA during hospitalization and 15.1% after discharge. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with in-hospital MRA were more frequently female (32.4 vs. 26.5%, <em>p</em><0.001) with a mean age of 68±13 years (vs. 67±13 years, <em>p</em>=0.014). Besides a higher prevalence of diabetes mellitus (40.9 vs. 31.7%, <em>p</em><0.001) and heart failure (7.6 vs. 5.2%, <em>p</em>=0.009), there were no other significant differences regarding the basal characteristics of the two groups. The mean LVEF was 44±3% for both groups. During hospitalization, patients receiving MRA presented frequent heart failure (40.6 vs. 15.2%, <em>p</em><0.001), shock (4.9 vs. 3.1%, <em>p</em>=0.02), invasive or non-invasive mechanical ventilation (3.9 vs. 1.4% and 4.0 vs. 1.4%, <em>p</em><0.001), atrial fibrillation (8.7 vs. 4.6%, <em>p</em><0.001), ventricular tachycardia (2.6 vs. 1.3%, <em>p</em>=0.006) and cardiac arrest (5.7 vs. 2.5%, <em>p</em><0.001). Despite the higher incidence of complications, in-hospital mortality rate didn’t differ between groups (2.4 vs. 2.2%, <em>p</em>=0.73).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">One year mortality rate was not significantly different in patients receiving MRA (HR= 1.39, 95%CI= 0.90-2.03, p=0.13), but there was a trend to higher risk of cardiovascular re-admission after one year (HR = 1.32, 95%CI 0.96-1.80, p=0.08). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>patients with mildly reduced LVEF receiving MRA had more in-hospital complications and a worse clinical profile, however, no significant differences were found in in-hospital and one year mortality rates. Randomized controlled trials are needed to further evaluate the impact of MRA in this population.</span></span></p>
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