Coronary disease & ACSMeta-analysis
Mineralocorticoid Receptor Antagonists in Myocardial Infarction Patients
- Systematic review and meta-analysis of randomised trials
- study-level
- fixed effect model
- Peto odds ratios (ORs)
Authors' conclusion
In post-MI patients, MRAs decrease the risk of all-cause mortality and new or worsening HF regardless of HF status.
Study context
- Population
- Post-MI patients
- Participants
- 18,111 patients · 11 trials
- Comparison
- Mineralocorticoid antagonist (MRA) vs no MRA
- MRAn = 9,064
- No MRAn = 9,047reference
- Outcome
- Death and new or worsening HF (key outcomes)
Pooled result
As reported in the abstract
MRA vs No MRAOdds ratio (95% CI)
death; I2 = 0%
0.85(0.76–0.95)
new or worsening HF; I2 = 26.8%
0.83(0.73–0.94)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| Death, post-MI HF trial vs post-MI non-HF trials (subgroup) — MRA vs No MRA | 0.84 (0.73–0.96) | |
| Death, post-MI HF trial vs post-MI non-HF trials (subgroup) — MRA vs No MRA | 0.87 (0.72–1.05) | |
| New or worsening HF, post-MI HF trial vs post-MI non-HF trials (subgroup) — MRA vs No MRA | 0.87 (0.74–1.01) | |
| New or worsening HF, post-MI HF trial vs post-MI non-HF trials (subgroup) — MRA vs No MRA | 0.75 (0.58–0.94) | |
| 0.512Odds ratio (log scale) |
- Death, post-MI heart failure (HF) trial vs post-MI non-HF trials (subgroup): post-MI HF trial: 478/3,319 vs 554/3,313; Risk difference (RD) −2.3% (95% CI −3.9% to −0.6%)
- Death, post-MI HF trial vs post-MI non-HF trials (subgroup): post-MI non-HF trials: 219/5,745 vs 249/5,734; RD −0.5% (95% CI −1.2% to 0.2%)
- Death, post-MI HF trial vs post-MI non-HF trials (subgroup): interaction P = 0.73
- New or worsening HF, post-MI HF trial vs post-MI non-HF trials (subgroup): post-MI HF trial: 345/3,319 vs 391/3,313; RD −1.4% (95% CI −2.8% to 0.1%)
- New or worsening HF, post-MI HF trial vs post-MI non-HF trials (subgroup): post-MI non-HF trials: 126/5,251 vs 167/5,241; RD −0.8% (95% CI −1.3% to −0.2%)
- New or worsening HF, post-MI HF trial vs post-MI non-HF trials (subgroup): interaction P = 0.29
Original publication
Mineralocorticoid Receptor Antagonists in Myocardial Infarction Patients. JACC Heart Fail. Published 5 July 2025. doi:10.1016/j.jchf.2025.102531
Summarised from the published abstract; every number is checked against it