The measurement of plasma aldosterone in patients post-myocardial infarction

Abstract

Aldosterone blockade, or more correctly mineralocorticoid receptor blockade (MRB), when administered between days 3 and 14 in patients with heart failure (HF) and left ventricular systolic dysfunction (LVSD) post-myocardial infarction (MI) has been shown to reduce all-cause mortality as well as hospitalizations for HF (EPHESUS).1 Of note, all-cause mortality was reduced by 31% at 30 days post-randomization.2 These benefits on mortality were seen in patients with an ST-segment elevation (STE) MI and in those with a non-ST-segment elevation (NST) MI, as well as in patients treated with ‘optimal’ medical therapy including an aspirin, statin, reperfusion, a diuretic, a β-adrenergic receptor blocker, and an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocking agent (ARB). This strategy has been adopted by both the European Society of Cardiology and the AHA/ACC guidelines. Unfortunately, aldosterone levels were not routinely measured in EPHESUS, thereby precluding further detailed insight into the pathophysiological role of aldosterone and risk stratification. Fortunately, this void has been filled by Begui et al. 3 who showed that patients with a STEMI in whom plasma aldosterone levels were measured on admission and were in the highest quartile had an increased risk of death compared with those in the lowest quartile. Palmer et al. 4 provide further insight into the prognostic value of plasma aldosterone levels in patients with a STEMI or NSTEMI in the absence of clinical evidence of HF. They found that plasma aldosterone levels in the highest tertile (>141 pmol/L) measured early (24–96 h) after admission for an MI were an independent predictor of survival … *Corresponding author. Tel:+1 734 936-5260, Fax: +1 734 936 5256. Email: bpitt{at}umich.edu