{
  "abstract": "Background The 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.Methods We 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.Results 15 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.Conclusions In 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.",
  "authors": [
    {
      "affiliations": [
        "Division of Cardiology, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA",
        "Internal Medicine, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA"
      ],
      "name": "Song Peng Ang"
    },
    {
      "affiliations": [
        "Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA"
      ],
      "name": "Jia Ee Chia"
    },
    {
      "affiliations": [
        "Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Bruno Bezerra Lima"
    },
    {
      "affiliations": [
        "Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA"
      ],
      "name": "Jose Iglesias"
    },
    {
      "affiliations": [
        "Internal Medicine, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA"
      ],
      "name": "Eunseuk Lee"
    },
    {
      "affiliations": [
        "HumanX, Delaware, Delaware, USA"
      ],
      "name": "Chayakrit Krittanawong"
    },
    {
      "affiliations": [
        "Cardiology, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Mahboob Alam"
    },
    {
      "affiliations": [
        "Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA",
        "Cardiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA"
      ],
      "name": "Debabrata Mukherjee"
    }
  ],
  "title": "Mineralocorticoid receptor antagonists for acute myocardial infarction: a systematic review and meta-analysis of randomised controlled trials",
  "uid": "8982d550-731a-510b-b054-3eaf68f97c11"
}