SynthesisOpen heart2025
Mineralocorticoid receptor antagonists for acute myocardial infarction: a systematic review and meta-analysis of randomised controlled trials.
Synthesis in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe role of mineralocorticoid receptor antagonists (MRAs) in acute myocardial infarction (MI) remains controversial, with conflicting evidence from landmark trials. We aimed to assess the impact of MRAs on mortality and cardiovascular outcomes post-acute MI.
methodsWe systematically searched PubMed, Embase and Cochrane CENTRAL databases up to February 2025 for randomised controlled trials comparing MRAs with placebo or standard care in adults experiencing acute MI. Primary outcome was all-cause mortality; secondary outcomes included cardiovascular mortality, heart failure, recurrent MI and ventricular arrhythmia. Data were pooled using random-effects models, with heterogeneity explored via subgroup analyses and meta-regression.
results15 trials (n=18 471) were included. MRA therapy demonstrated non-significant reductions in all-cause mortality (OR 0.80, 95% CI 0.55 to 1.18), cardiovascular mortality (OR 0.84, 95% CI 0.59 to 1.18), heart failure (OR 0.76, 95% CI 0.52 to 1.12), recurrent MI (OR 0.92, 95% CI 0.67 to 1.27) and ventricular arrhythmia (OR 0.83, 95% CI 0.47 to 1.47). Subgroup analyses revealed that trials with >6 months follow-up demonstrated modest cardiovascular mortality reduction (OR 0.86, 95% CI 0.75 to 0.99). Effects were consistent across MRA types, left ventricular ejection fraction categories and initiation timing. Meta-regression showed no significant effect modifiers among baseline characteristics or concomitant therapies.
conclusionsIn MI populations, MRA therapy did not significantly improve mortality or cardiovascular outcomes in the short term. However, a significant reduction in cardiovascular mortality emerged after 6 months, alongside a non-significant trend towards less heart failure, indicating potential benefits for high-risk patients with longer-term treatment rather than routine use in all acute MI cases.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.