017 Aldosterone receptor blockade at presentation for ST elevation myocardial infarction is associated with a reduction in potentially lethal ventricular arhythmia

TitleAldosterone receptor blockade at presentation for ST elevation myocardial infarction is associated with a reduction in potentially lethal ventricular arrhythmia.PurposeTo assess the benefit of aldosterone receptor blockade on admission for primary PCI for STEMI.Methods806 consecutive patients admitted within 12 hours after onset of a STEMI for primary PCI were studied. The latest 111 patients were systematically treated by 200mg IV potassium canrenonate at presentation, followed by soludactone 25mg daily during the hospital stay. The association between aldosterone receptor blockade and in-hospital death, ischemic events and ventricular arrhythmia was assessed using a logistic model adjusted on age, Killip class and reperfusion status. Follow-up was completed in 97% and 96% of patients at 30 days and 6 months.ResultsResults are depicted in the table. Baseline characteristics were not different between the 2 groups (age 63±14 vs 62±15, successful reperfusion 87% vs 90% and Killip class IV 5% in both groups).Aldosterone receptor blockade was associated with significantly lower rates of ventricular arrhythmia with an adjusted OR of 0.18 (95%CI 0.07–0.47) and 0.25 (95%CI 0.11–0.57) for the ventricular tachycardia and ventricular tachycardia or fibrillation respectively, and a trend towards lower rates of resuscitated cardiac arrest and high grade atrioventricular block. Mortality rates at 30 days (6 vs 6.7%) and 6 months (6.8 vs 7%) were comparable between the groups.ConclusionsAldosterone receptor blockade at presentation for STEMI is associated with a marked reduction of the risk of potentially lethal ventricular arrhythmia. These findings underline the anti-arrhythmic effect of aldosterone blockade and the need for adequately sized randomized trials to assess the benefit of such strategy on major cardiovascular events.No aldosterone blockade(n=695)Aldosterone blockade(n=111)pIn-hospital Death5.3%6.31%NSRessucitated cardiac arrest7.2%6.4%NSDeath or ressucitated cardiac arrest8.4%7.3%NSRecurrent ischemia5%3.6%NSV tach-V Fib25.6%7.3%<0.0001V tach24.6%5.45%