Abstract 17144: Utilization and Safety of Aldosterone Blockers in Patients with Left Ventricular Dysfunction Following Acute Myocardial Infarction: Real World Data from the Acute Coronary Syndrome Israeli Surveys: 2004 - 2010

Abstract

Background: Following the EPHESUS trial, published in 2003, aldosterone blocker therapy among acute MI patients with left ventricular dysfunction and heart failure or diabetes mellitus received a class I indication in this high risk population. We sought to assess the implementation of this indication in a real world setting among patients enrolled in the Acute Coronary Syndrome Israeli Surveys (ACSIS).

Methods: The study population comprised 955 patients from ACSIS 2004-2010 who met the guideline criteria for treatment with aldosterone blockers including serum creatinine ≤2.4 mgx005C;dL, left ventricular ejection fraction (LVEF) ≤40% and Killip class >I or diabetes mellitus.

Results: Among 7,696 patients enrolled in the ACSIS surveys from 2004, 955 (12%) were eligible for aldosterone blocker treatment. In this population aldosterone blocker therapy has increased from 20.6% to 25.4% over the six-year period, whereas utilization of other guideline recommended drugs, including ACE-I/ARBs and beta-blockers, was >2-fold higher (Figure). In a multivariate-adjusted logistic regression analysis, independent predictors of aldosterone blocker utilization included a higher degree of left ventricular dysfunction (LVEF ≤30% vs. 31-40%: odds ratio [OR] = 2.25; 95% confidence interval [CI], 1.14-4.45) and a higher Killip class on admission (Killip ≥II vs. I: OR = 1.72; 95% CI, 1.16-2.55). There was no significant difference in creatinine level between patients with and without aldosterone blocker treatment. Major adverse cardiac events or rehospitalization rates at 30 days following discharge were similar among both groups.

Conclusions: In a real world setting, less than one third of acute MI patients eligible for treatment with an aldsoterone blocker received this mode of medical therapy. Aldosterone blocker utilization in this population was not associated with an increased risk for adverse events or rehospitalization at 30 days of follow-up.