Spironolactone lowers the rate of repeat revascularization in acute myocardial infarction patients treated with percutaneous coronary intervention

Abstract

We sought to assess the effect of the aldosterone receptor blocker, spironolactone, on 1-year clinical outcomes in all-comers with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention. A total of 10,309 AMI patients were recruited between November 2005 and April 2008 from a nationwide AMI registry in Korea. Patients were divided into 2 groups: those treated with spironolactone (n = 720; 7.0%) and those who had not been treated at discharge. The primary end point was major adverse cardiac events (MACEs), defined as the composite of death from any cause, recurrent AMI, or repeat revascularization at 1 year after admission. The spironolactone group had a greater number of comorbidities than the nonspironolactone group. There was no significant association between the spironolactone treatment and MACE at 1 year (adjusted hazard ratio [HR] 0.95, 95% confidence interval 0.72-1.24, P = .69) in the overall population. The risks of death from any cause, cardiac death, and recurrent AMI were also similar between the groups. However, patients who received spironolactone had a lower risk of repeat revascularization than did those who did not receive spironolactone (adjusted HR 0.58, 95% CI 0.39-0.86, P = .007). Of guideline-eligible patients (n = 821/10,309; 8.0%), 170 (20.7%) of 821 patients received a spironolactone at hospital discharge. When limited to the guideline-eligible patients' population, a statistical trend toward lower MACE was observed in patients treated with spironolactone (14.3% vs 13.7%, adjusted HR 0.63, 95% CI 0.37-1.10, P = .10). All-comer AMI patients undergoing percutaneous coronary intervention who received spironolactone had a lower risk of repeat revascularization. Randomized trials are needed.