- Question
- Does adding early mineralocorticoid receptor blockade to standard therapy improve outcomes in patients with acute myocardial infarction, regardless of the presence of heart failure or left ventricular dysfunction?
- Design
- Randomized, phase 3, open-label (unmasked) trial enrolling 1603 patients with 6 months of follow-up, sponsored by Assistance Publique - Hôpitaux de Paris.
- Population
- Patients admitted with acute myocardial infarction, treated with or without reperfusion, who did not need to have heart failure or left ventricular dysfunction.
- Intervention
- A single intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg once daily) for 6 months, added to standard therapy.
- Control
- Standard therapy alone, without additional aldosterone blockade.
- Primary outcome
- Composite of death, resuscitated cardiac arrest, significant ventricular arrhythmia, indication for an implantable defibrillator, or new or worsening heart failure at 6 months.
- Results
- The primary outcome occurred in 95 patients (11.8%) in the treatment group and 98 (12.2%) in the control group (HR 0.97; 95% CI 0.73 to 1.28). Death occurred in 11 (1.4%) versus 17 (2.1%) (HR 0.65; 95% CI 0.30 to 1.38).
- Safety
- Hyperkalemia >5.5 mmol/l occurred in 3% of the treatment group and 0.2% of the standard therapy group (p < 0.0001).
- Conclusion
- The trial failed to show a benefit of early mineralocorticoid receptor antagonist use added to standard therapy in patients admitted with myocardial infarction.
- Why it matters
- It showed that routine early aldosterone blockade in all patients with myocardial infarction, regardless of heart failure or ventricular dysfunction, does not provide a demonstrable overall benefit, while an exploratory analysis in ST-segment elevation infarction generated hypotheses for later studies.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026