Efficacy of mineralocorticoid receptor antagonists in postmyocardial infarction patients with or without left ventricular dysfunction: A meta-analysis of randomized controlled trials.
Efficacy of mineralocorticoid receptor antagonists in postmyocardial infarction patients with or without left ventricular dysfunction: A meta-analysis of randomized controlled trials.
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盐皮质激素受体拮抗剂对伴或不伴左心室功能障碍的心肌梗死后患者的疗效：随机对照试验的荟萃分析。
DOI：
10.1097/md.0000000000013690
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Cheng X
中科院分区：
文献类型：
--
作者：
Xu Y;Qiu Z;Yang R;Wu Y;Cheng X
背景：在有或无左心功能不全(LVD)的心肌梗死(MI)入院患者中，关于在标准治疗的基础上使用盐皮质激素受体拮抗剂(MRAs)的好处存在激烈的争论。方法：随机对照试验(RCT)从开始到2018年4月通过正式的电子数据库(PubMed、EMBASE、Cochrane Library、Ovid和临床试验)进行扫描。使用Review Manager 5.3进行Meta分析，以确定报告MRAs在有或无左室肥厚的心肌梗死后患者中的疗效的研究。结果：13项随机对照试验，涉及11,365人，符合研究条件。在心肌梗死后患者中，MRAS治疗使全因死亡率降低了16%，心血管死亡率降低了16%，心力衰竭(HF)死亡率降低了22%。使用MRAS的心梗后LVD患者全因死亡率和心血管死亡分别降低13%和15%，而无LVD的MI后患者全因死亡率和心血管死亡无显著差异(相对比[RR]0.83，95%可信区间[CI]0.26-2.69，P=0.05)。76，I2=0%，相对危险度1.01，95%可信区间0.33~3.09，P=.99，I2=0%)。在6例急性心肌梗死后RCT患者中，MRAS治疗对改善左心室射血分数(LVEF)有显著作用(平均差值3.33，95%CI 0.91~5.75，P=0.000)。007，I2=94%)。接受MRAS治疗的患者与未接受MRAS治疗的患者相比，其复发心肌梗死或再次血管重建的发生率并未降低(RR为0.95，95%CI[0.80~1.12]，P=0.05)。54，I2=0%；RR 1.09，95%CI[0.79~1.50]，P=。61，I2=0%)。然而，接受MRAS治疗的患者与未接受MRAS治疗的患者相比，高钾血症的发生率显著增加(RR 2.05，95%CI[1.60，2.61]，P<；00001，I2=49%)。结论：MRAS治疗降低了心梗后患者的全因死亡率、心血管死亡和心力衰竭死亡。MRAS治疗后的左心室射血分数也有显著改善。MRAS可降低LVD患者的心血管死亡和全因死亡率。依普利酮显著降低了心肌梗塞后患者的全因死亡率和心血管死亡。然而，在没有LVD的MI后患者中，MRAS没有显示出任何心血管益处。
Background:There is heated debate about the benefits of using mineralocorticoid receptor antagonists (MRAs) in addition to standard therapy in patients admitted for myocardial infarction (MI) with or without left ventricular dysfunction (LVD).Methods:Randomized controlled trials (RCTs) were scanned by a formal search of electronic databases (PubMed, EMBASE, Cochrane Library, Ovid, and clinical trials) from their inception to April 2018. A meta-analysis was conducted using Review Manager 5.3 to identify studies reporting the efficacy of MRAs use in post-MI patients with or without LVD.Results:Thirteen RCTs involving 11,365 individuals were eligible for this study. MRAs treatment reduced all-cause mortality by 16%, cardiovascular death by 16%, and death from heart failure (HF) by 22% in post-MI patients. MRAs use reduced all-cause mortality by 13% and cardiovascular death by 15% in post-MI patients with LVD, but there was no significant difference in all-cause mortality and cardiovascular death in post-MI patients without LVD (relative ratios [RR] 0.83, 95% confidence interval [CI] 0.26–2.69, P=. 76, I 2= 0%; RR 1.01, 95% CI 0.33–3.09, P=. 99, I 2= 0%). In 6 RCTs involving post-MI patients, MRAs treatment had a significant effect on improving left ventricular ejection fraction (LVEF)(mean difference 3.33, 95% CI 0.91–5.75, P=. 007, I 2= 94%). Patients treated with MRAs did not show a decrease in recurrent MI or repeat revascularization compared with patients treated without MRAs (RR 0.95, 95% CI [0.80–1.12], P=. 54, I 2= 0%; RR 1.09, 95% CI [0.79–1.50], P=. 61, I 2= 0%). However, MRAs treatment significantly increased the incidence of hyperkalemia compared with patients treated without MRAs (RR 2.05, 95% CI [1.60, 2.61], P<. 00001, I 2= 49%).Conclusion:MRAs treatment reduced all-cause mortality, cardiovascular death, and death from HF in post-MI patients. MRAs treatment also demonstrated a significant improvement in LVEF. MRAs reduced cardiovascular death and all-cause mortality in patients with LVD. Eplerenone significantly reduced all-cause mortality and cardiovascular death in post-MI patients. However, MRAs failed to show any cardiovascular benefit in post-MI patients without LVD.