Title
Aldosterone receptor blockade at presentation for ST elevation myocardial infarction is associated with a reduction in potentially lethal ventricular arrhythmia.
Purpose
To assess the benefit of aldosterone receptor blockade on admission for primary PCI for STEMI.
Methods
806 consecutive patients admitted within 12 hours after onset of a STEMI for primary PCI were studied. The latest 111 patients were systematically treated by 200 mg IV potassium canrenonate at presentation, followed by soludactone 25 mg daily during the hospital stay. The association between aldosterone receptor blockade and in-hospital death, ischemic events and ventricular arrhythmia was assessed using a logistic model adjusted on age, Killip class and reperfusion status. Follow-up was completed in 97 % and 96 % of patients at 30 days and 6 months.
Results
Results are depicted in the table. Baseline characteristics were not different between the 2 groups (age 63 ¡À 14 vs 62 ¡À 15, successful reperfusion 87 % vs 90 % and Killip class IV 5 % in both groups).Aldosterone receptor blockade was associated with significantly lower rates of ventricular arrhythmia with an adjusted OR of 0.18 (95 % CI 0.07?.47) and 0.25 (95 % CI 0.11?.57) for the ventricular tachycardia and ventricular tachycardia or fibrillation respectively, and a trend towards lower rates of resuscitated cardiac arrest and high grade atrioventricular block. Mortality rates at 30 days (6 vs 6.7 % ) and 6 months (6.8 vs 7 % ) were comparable between the groups.
Conclusions
| No aldosterone blockade
(n = 695) | Aldosterone blockade
(n = 111) | p |
|---|
| In-hospital Death | 5.3 % | 6.31 % | NS |
| Ressucitated cardiac arrest | 7.2 % | 6.4 % | NS |
| Death or ressucitated cardiac arrest | 8.4 % | 7.3 % | NS |
| Recurrent ischemia | 5 % | 3.6 % | NS |
| V tach-V Fib | 25.6 % | 7.3 % | <0.0001 |
| V tach | 24.6 % | 5.45 % | <0.00001 |
| High grade AV block | 5.8 % | 1.8 % | 0.08 |
