Background. A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. Objective. To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Methods. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020. Results. 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); ) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), ) 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), ). 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), ) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), ). 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), ), left ventricular end-systolic index (MD: -4.52 ml/m², 95% CI (-8.21, -0.83), ), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), ). The corresponding RR were 1.72 (95% CI (1.43, 2.07), ) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction). Conclusions. 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.

中文翻译：

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急性心肌梗死中的醛固酮阻断：系统评价和荟萃分析

背景。缺乏对盐皮质激素受体拮抗剂 (MRA) 对急性心肌梗死 (AMI) 患者的益处的综合评估。目标。总结 MRA 在 AMI 入院患者中的有效性和安全性的证据。方法。文章是通过 PubMed、Embase、Cochrane 图书馆、Ovid (Medline1946-2021) 和 ClinicalTrials.gov 数据库从开始到 2020 年 12 月 31 日确定的。结果。共纳入 15 篇文章，共 11,861 名患者。MRA 将全因死亡风险降低了 16%（相对比 (RR)：0.84；95% 置信区间 (CI) (0.76, 0.94)；)和心血管不良事件的发生率增加 12% (RR: 0.88, 95% CI (0.83, 0.93),)在 AMI 后患者中，进一步分析表明，在 AMI 后 7 天内早期施用 MRA 可更大程度地降低全因死亡率 (RR: 0.72, 95% CI (0.61, 0.85)，）。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，全因死亡率降低了 36%（RR：0.64，95% CI (0.46, 0.89)，)和心血管不良事件减少 22% (RR: 0.78, 95% CI (0.67, 0.91)，）。同时，没有 LVSD 的 STEMI 后患者接受 MRA 治疗后左心室射血分数显着改善（平均差 (MD)：2.69，95% CI (2.44, 2.93)，),左心室收缩末期指数 (MD: -4.52 ml/m ² , 95% CI (-8.21, -0.83),),和左心室舒张末期直径 (MD: -0.11 cm, 95% CI (-0.22, 0.00),）。相应的 RR 为 1.72（95% CI (1.43, 2.07)，)用于考虑常见的不良事件（高钾血症、男性乳房发育症和肾功能不全）。结论。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，这在没有 LVSD 的 STEMI 后患者中更为显着。此外，MRA 治疗可能对无 LVSD 的 STEMI 后患者心脏重构的逆转产生有益影响。