ALBATROSS: No Benefit of Early Aldosterone Blockade in AMI

Myocardial infarction (MI) patients without heart failure derive no benefit from the addition of mineralocorticoid receptor antagonists (MRA) to standard therapy, according to results of the ALBATROSS Trial presented Aug. 30 during ESC Congress 2015 in London.

Researchers investigated the effects of prolonged MRA therapy initiated early after the onset of MI in 1,622 patients (92 percent without heart failure) who were randomly assigned to standard therapy alone (n=801) or with the addition of MRA therapy (n=802). Standard therapy included in-hospital medications as well as procedures such as coronary angiography, percutaneous coronary intervention and coronary bypass grafting. The MRA regimen consisted of an intravenous bolus of potassium canrenoate (200 mg) followed by an initial 25 mg of oral spironolactone within 12 to 24 hours, and then daily for six months. Spironolactone was not given if either potassium or creatinine concentrations were uncontrolled.

Results showed that after a median follow-up of 118 days, the primary endpoint of resuscitated cardiac arrest, significant ventricular arrhythmia, indication for an implantable defibrillator, or new or worsening heart failure at 6-months occurred at a similar rate in both the treatment and control groups (11.8 percent and 12.2 percent respectively). However, investigators noted that MRA did reduce the odds of death in the subgroup of patients with ST-segment elevation myocardial infarction (STEMI).

"Our results suggest that heart failure is the main factor for the favorable effect of MRAs previously observed in MI patients," said principal investigator Gilles Montalescot, MD, PhD. "In MI patients without heart failure we observed no benefit. We suggest to respect the current indication driven by heart failure."

Regarding the STEMI results, Montalescot stressed that they should be interpreted with great caution. "It is an intriguing, hypothesis-generating finding which needs to be examined further in adequately-sized trials specifically dedicated to STEMI patients," he said.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC Congress, Aldosterone, Anterior Wall Myocardial Infarction, Mineralocorticoid Receptor Antagonists, Arrhythmias, Cardiac, Canrenoic Acid, Coronary Angiography, Creatinine, Defibrillators, Implantable, Heart Arrest, Heart Conduction System, Heart Failure, Myocardial Infarction, Percutaneous Coronary Intervention, Potassium, Spironolactone

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