Aldosterone Antagonists Might Benefit Patients Who Have ST-Segment–Elevation Myocardial Infarction Without Heart Failure

Aldosterone antagonists (i.e., spironolactone, eplerenone, or canrenoate [canrenoate is not available in the U.S.]) are recommended to prevent ventricular remodeling and fibrosis in patients with ST-segment–elevation myocardial infarctions (STEMIs) and left ventricular ejection fraction (LVEF) ≤40% with clinical heart failure. Whether aldosterone antagonists benefit patients without clinical heart failure or with higher LVEF is unclear. In this meta-analysis, investigators identified 10 randomized clinical trials (involving 4147 patients without heart failure or with LVEF >40%) in which aldosterone antagonists were compared with placebo controls in STEMI patients. All patients had undergone percutaneous coronary interventions, thrombolysis,…