PMID- 22200184
OWN - NLM
STAT- MEDLINE
DCOM- 20140303
LR  - 20130604
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 167
IP  - 1
DP  - 2013 Jul 15
TI  - Early mineralocorticoid receptor blockade in primary percutaneous coronary 
      intervention for ST-elevation myocardial infarction is associated with a 
      reduction of life-threatening ventricular arrhythmia.
PG  - 73-9
LID - S0167-5273(11)02133-4 [pii]
LID - 10.1016/j.ijcard.2011.11.076 [doi]
AB  - BACKGROUND: Aldosterone levels are high early after admission for ST elevation 
      myocardial infarction (STEMI) concomitantly with high risk of sudden death and 
      life-threatening ventricular arrhythmia. METHODS: We assessed the hypothesis that 
      early aldosterone blockade on admission for primary percutaneous coronary 
      intervention (PCI) may be associated with a reduction of life-threatening 
      ventricular arrhythmia in a prospective cohort-nested case (n=159) versus 
      historical control (n=623) study. All cases were treated on admission by 200mg IV 
      bolus of potassium canrenoate, followed by 25mg PO spironolactone daily during 
      the coronary care unit stay. The primary endpoint--in-hospital composite of 
      death, resuscitated cardiac arrest and ventricular tachycardia--was assessed by 
      logistic regression models adjusted on major pre-specified variables and 
      validated by a bootstrap procedure and propensity-score based analyses. RESULTS: 
      Aldosterone blockade was associated with lower risks of the primary endpoint 
      (adjusted ORs 0.26, 95% CI [0.13-0.57]), resuscitated cardiac arrest (adjusted OR 
      0.39, 95% CI [0.16-0.94]), ventricular tachycardia or fibrillation (adjusted ORs 
      0.23, 95% CI [0.12-0.45]), as well as ventricular arrhythmia requiring 
      resuscitation or anti-arrhythmic therapy (adjusted OR 0.41, 95% CI [0.19-0.88]). 
      All findings were confirmed by the bootstrap procedure. The benefit on death or 
      resuscitated cardiac arrest seemed sustained at 6month follow-up. CONCLUSIONS: 
      Early aldosterone blockade in patients presenting for primary PCI for STEMI is 
      associated with significant reductions in rates of life-threatening arrhythmia 
      and cardiac arrest independent of the initial risk profile, heart failure or 
      hemodynamic status. These findings support the concept of aldosterone blockade 
      early after STEMI, warranting further confirmation by ongoing randomized trials.
CI  - Copyright (c) 2011 Elsevier Ireland Ltd. All rights reserved.
FAU - Beygui, Farzin
AU  - Beygui F
AD  - Cardiology Department, Pitie-Salpetriere University Hospital, APHP, 75013 Paris, 
      France; INSERM U937, France.
FAU - Labbe, Jean-Philippe
AU  - Labbe JP
FAU - Cayla, Guillaume
AU  - Cayla G
FAU - Ennezat, Pierre-Vladimir
AU  - Ennezat PV
FAU - Motreff, Pascal
AU  - Motreff P
FAU - Roubille, Francois
AU  - Roubille F
FAU - Silvain, Johanne
AU  - Silvain J
FAU - Barthelemy, Olivier
AU  - Barthelemy O
FAU - Delarche, Nicolas
AU  - Delarche N
FAU - Van Belle, Eric
AU  - Van Belle E
FAU - Collet, Jean-Philippe
AU  - Collet JP
FAU - Montalescot, Gilles
AU  - Montalescot G
LA  - eng
PT  - Journal Article
DEP - 20111224
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Mineralocorticoid Receptor Antagonists)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Injections, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Mineralocorticoid Receptor Antagonists/*administration & dosage
MH  - Myocardial Infarction/*mortality/*therapy
MH  - *Percutaneous Coronary Intervention/methods
MH  - Prospective Studies
MH  - Tachycardia, Ventricular/*mortality/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2011/12/28 06:00
MHDA- 2014/03/04 06:00
CRDT- 2011/12/28 06:00
PHST- 2011/09/08 00:00 [received]
PHST- 2011/10/28 00:00 [revised]
PHST- 2011/11/27 00:00 [accepted]
PHST- 2011/12/28 06:00 [entrez]
PHST- 2011/12/28 06:00 [pubmed]
PHST- 2014/03/04 06:00 [medline]
AID - S0167-5273(11)02133-4 [pii]
AID - 10.1016/j.ijcard.2011.11.076 [doi]
PST - ppublish
SO  - Int J Cardiol. 2013 Jul 15;167(1):73-9. doi: 10.1016/j.ijcard.2011.11.076. Epub 
      2011 Dec 24.