Life-Saving Drug or Potential Threat? The Role of Mineralocorticoid Receptor Antagonists in Myocardial Infarction: A...

Mineralocorticoid receptor antagonists (MRAs) have been studied as a potential therapeutic option to improve outcomes in patients with myocardial infarction (MI). Although several randomized controlled trials have evaluated the effectiveness of MRAs in post-MI patients, the specific effects remain debated. We systematically searched databases including Web of Science, PubMed, Embase, and Cochrane Library. The primary efficacy outcome was death from any cause. Secondary efficacy outcomes included death from cardiovascular causes, death from MI, and others. Subgroup analyses were performed based on the presence of heart failure and the type of MRA used. Safety outcomes included hyperkalemia, hypokalemia, breast tenderness, and gynecomastia. A total of 13 randomized controlled trials involving 17 851 patients were included. The results demonstrated that MRAs significantly reduced the risk of death from any cause (relative risk [RR] 0.87; 95% CI 0.79-0.95; P = .004). Subgroup analysis indicated that the effectiveness of MRAs varied based on the presence of heart failure. MRAs significantly reduced the risk of death from cardiovascular causes in heart failure patients (RR 0.87; 95% CI 0.78-0.97), but had no significant effect in patients without heart failure (RR 0.69; 95% CI 0.34-1.38). Furthermore, subgroup analysis based on different MRA drugs showed varying effects on outcomes. While some adverse events, such as hyperkalemia (RR 1.95; 95% CI 1.55-2.46; P < .01), were significantly more frequent, other safety events did not show significant differences. MRAs improve cardiovascular outcomes in MI patients, especially in those with heart failure. When choosing a specific MRA drug, eplerenone or spironolactone is recommended.