Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.
Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.
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DOI：
10.1155/2021/1710731
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发表时间：
2021
影响因子：
3.1
通讯作者：
Lu C
中科院分区：
文献类型：
--
作者：
Chen Q;Zhao D;Sun J;Lu C
盐皮质激素受体拮抗剂（MRA）在急性心肌梗死（AMI）患者中的益处缺乏综合评价。 目的总结MRA在AMI患者中的有效性和安全性证据。 通过PubMed、Embase、科克伦图书馆、奥维德（Medline 1946 -2021）和ClinicalTrials.gov数据库识别了自成立至2020年12月31日的文章。 纳入了15篇文章，共11，861例患者。MRA使全因死亡率降低了16%（相对比率（RR）：0.84; 95%置信区间（CI））（0.76，0.94）; P = 0.002），心血管不良事件发生率降低12%（RR：0.88，95%CI（0.83，0.93），P < 0.00001），进一步分析表明，AMI后7天内早期给予MRA可使全因死亡率大幅降低（RR：0.72，95% CI（0.61，0.85），P < 0.0001）。亚组分析显示，无左心室收缩功能障碍（LVSD）的STEMI后患者接受MRA治疗后，全因死亡率降低36（RR：0.64，95% CI（0.46，0.89），P = 0.007），心血管不良事件减少22%（RR：0.78，95% CI（0.67，0.91），P = 0.002）。同时，STEMI后无LVSD患者经MRA治疗后左室射血分数明显改善（平均差异（MD）：2.69，95% CI（2.44，2.93），P < 0.00001），左室收缩末期指数左室舒张末期内径（MD：-0.11cm，95%CI（-0.22，0.00），P = 0.05）。常见不良事件（高钾血症、男性乳房发育和肾功能不全）的相应RR为1.72（95% CI（1.43，2.07），P < 0.00001）。 我们的研究结果表明，MRA治疗降低了AMI后患者的全因死亡率和心血管不良事件，这在无LVSD的STEMI后患者中更为显著。此外，MRA治疗可能对无LVSD的STEMI患者的心脏重塑逆转产生有益影响。
A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020. 15 articles with a total of 11,861 patients were included. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR): 0.84; 95% confidence interval (CI) (0.76, 0.94); P = 0.002) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), P < 0.00001) in post-AMI patients, and further analysis demonstrated that early administration of MRA within 7 days after AMI resulted in a greater reduction in all-cause mortality (RR: 0.72, 95% CI (0.61, 0.85), P < 0.0001). Subgroup analyses showed that post-STEMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA had a 36% reduction in all-cause mortality (RR: 0.64, 95% CI (0.46, 0.89), P = 0.007) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), P = 0.002). Meanwhile, post-STEMI patients without LVSD treated with MRA get significant improvements in left ventricular ejection fraction (mean difference (MD): 2.69, 95% CI (2.44, 2.93), P < 0.00001), left ventricular end-systolic index (MD: -4.52 ml/m2, 95% CI (-8.21, -0.83), P = 0.02), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), P = 0.05). The corresponding RR were 1.72 (95% CI (1.43, 2.07), P < 0.00001) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction). Our findings suggest that MRA treatment reduces all-cause mortality and cardiovascular adverse events in post-AMI patients, which is more significant in patients after STEMI without LVSD. In addition, MRA treatment may exert beneficial effects on the reversal of cardiac remodeling in patients after STEMI without LVSD.
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影响因子：
168.9
作者：
Moher, D;Pham, B;Klassen, TP
通讯作者：
Klassen, TP
影响因子：
18.2
作者：
Adamopoulos, Chris;Ahmed, Ali;Zannad, Faiez
通讯作者：
Zannad, Faiez
影响因子：
37.8
作者：
Hayashi, M;Tsutamoto, T;Horie, M
通讯作者：
Horie, M
影响因子：
4.8
作者：
Di Pasquale, P;Cannizzaro, S;Paterna, S
通讯作者：
Paterna, S
影响因子：
5.8
作者：
Bollag, Wendy B.
通讯作者：
Bollag, Wendy B.