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(Circulation. 2003;107:2525.)
© 2003 American Heart Association, Inc.

Editorial

Aldosterone Blockade in Patients With Acute Myocardial Infarction

Bertram Pitt, MD

From the Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.

Correspondence to Bertram Pitt, MD, Department of Internal Medicine, University of Michigan Medical Center, 1500 East Medical Center Drive, 3910 Taubman Center, Ann Arbor, MI 30306. E-mail bpitt@umich.edu

Key Words: Editorials • myocardial infarction • ventricles

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Aldosterone blockade (AB) has found increasing use in patients with severe heart failure due to systolic left ventricular dysfunction based on the results of the Randomized ALdactone Evaluation Study (RALES).¹ The role of AB in patients with acute myocardial infarction has been uncertain, however. This situation is about to change with the availability of the results of the Eplerenone Post acute myocardial infarction Heart failure Efficacy and SUrvival Study (EPHESUS)² and the results of the study by Hayashi et al³ in this issue of Circulation.

See p 2559

The EPHESUS study² of over 6600 patients with acute myocardial infarction complicated by evidence of systolic left ventricular dysfunction (left ventricular ejection fraction 40%) and signs of heart failure showed that the selective AB with eplerenone, when administered at a dose of up to 50 mg daily (mean dose 42 mg daily) between days 3 and 14 after infarction (mean 7.3 days) in addition to standard therapy which could include reperfusion, aspirin, statins, angiotensin-converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB), and a ß-blocker, resulted in a 15% reduction in total mortality (P=0.008) and a 17% reduction in cardiovascular mortality (P=0.005), mainly due to a 21% reduction in sudden cardiac death (P=0.03). There was also a 13% (P=0.002) reduction in the co-primary endpoint of cardiovascular mortality/cardiovascular hospitalization (including hospitalization for non-fatal myocardial infarction, non-fatal stroke, heart failure, and ventricular arrhythmias). The reduction in cardiovascular hospitalizations was mainly attributable to a 15% (P=0.03) . . . [Full Text of this Article]

Related Article:

Immediate Administration of Mineralocorticoid Receptor Antagonist Spironolactone Prevents Post-Infarct Left Ventricular Remodeling Associated With Suppression of a Marker of Myocardial Collagen Synthesis in Patients With First Anterior Acute Myocardial Infarction

Masaru Hayashi, Takayoshi Tsutamoto, Atsuyuki Wada, Takashi Tsutsui, Chitose Ishii, Keijin Ohno, Masanori Fujii, Atsushi Taniguchi, Tomokazu Hamatani, Yoshitaka Nozato, Ken Kataoka, Naoki Morigami, Masato Ohnishi, Masahiko Kinoshita, and Minoru Horie
Circulation 2003 107: 2559-2565. [Abstract] [Full Text]

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