Effect of spironolactone on cardiac remodeling after acute myocardial infarction

doi:10.5847/wjem.j.issn.1920-8642.2013.01.009

Abstract

Abstract:

BACKGROUND: Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI.
METHODS: A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up.
RESULTS: The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LAD-SI were significantly improved in the treatment group compared with the control group at one year (P<0.05). In the treatment group, LVESD, LVEDD, LVPWT, LVEF, LAD-ML and LAD-SI were more significantly improved at one year than one month (P<0.05, P=0.007 to LVEF), and in the control group LVEF was more significantly improved at one year than one month (P=0.0277). There were no significant differences in serum potassium and serum creatinine levels between the two groups.
CONCLUSION: On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.

Key words: Myocardial infarction, acute, Ventricular remodeling, Atrial remodeling, Aldosterone, Aldosterone blockade, Spironolactone, Cardiac function, Prognosis

Chun-tao Wu, Zhong-hua Wang, Zhu-qin Li, Lan-feng Wang. Effect of spironolactone on cardiac remodeling after acute myocardial infarction[J]. World Journal of Emergency Medicine, 2013, 4(1): 48-53.

Figures/Tables 8

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References 18

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Variables	Control group (n=266)	Treatment group (n=262)	t /χ²	P
Age (y)	59.9±10.3	59.8±11.7	0.1042	>0.05
Male/Female	192/74	193/69	0.1471	0.7013
Past medical history (n, %)
Hypertension	117 (44)	123 (47)	0.4669	0.4944
Diabetes mellitus	53 (20)	50 (19)	0.0594	0.8074
Hypercholesterolemia	85 (32)	76 (29)	0.5410	0.4620
Current smoker	136 (51)	141 (54)	0.3827	0.5362
Earlier angina	64 (24)	60 (23)	0.0987	0.7534
Admission state (n, %)
Heart failure	4 (1.5)	4 (1.4)	0.1120	0.7379
Blood pressure (mmHg)
Systolic	118.3±9.8	117.2±10.3	1.2573	0.2092
Diastolic	72.5±5.5	73.2±5.7	1.4361	0.1516
Infarction location (n, %)
Anterior wall (±lateral wall)	140 (52.6)	137 (52.3)	0.0062	0.9374
Inferior wall (±posterior wall)	126 (47.4)	125 (47.7)	0.0062	0.9374
Baseline therapies (n, %)
Thrombolysis	76 (28.5)	79 (30)	0.1591	0.6900
PCI	99 (37.4)	116 (44.1)	2.7230	0.0989
Time from symptom onset to recanalization (h)	5.8±3.1	5.4±2.9	1.5306	0.1265
No recanalization treatment	93 (35)	100 (38)	0.5848	0.4444
Standard therapy (n, %)
ACEI / ARB	250 (94)	246 (94)	0.0020	0.9647
Beta-blockers	247 (93)	247 (99)	0.4403	0.5070
Statins	247 (92.9)	246 (93.9)	0.2289	0.6324
Aspirin	261 (98.2)	258 (98.3)	0.0005	0.9817
Clopidogrel	250 (94)	252 (96)	1.3624	0.2431
Time from AMI to study drug (h)	—	17.1±3.8	—	—

SRFT (mm)	Control group (n=266)				Treatment group (n=262)				Inter-group comparison at 12 mon
SRFT (mm)	1 mon	12 mon	t	P	1 mon	12 mon	t	P	t	P
LVESD	40.4±5.10	40.2±5.50	0.43	0.66	40.8±6.70	35.7±4.60	10.16	<0.05	10.204	<0.05
LVEDD	53.2±5.71	52.8±5.54	0.82	0.41	53.4±6.60	51.1±5.40	4.37	<0.05	3.5699	0.0004
IVST	10.48±1.38	10.52±1.47	0.32	0.75	10.35±1.87	10.42±1.62	0.46	>0.05	0.743	0.4578
LVPWT	10.35±1.18	10.42±1.21	0.68	0.50	10.24±1.25	10.50±1.09	2.54	<0.05	0.7978	0.4253
LVEF (%)	50.12±11.34	52.35±12.01	2.20	0.03	52.05±12.08	54.86±11.69	2.71	0.0070	2.433	0.0153
LAD-ML	39.84±5.20	39.94±5.10	0.22	0.82	39.23±5.65	38.24±5.05	2.12	0.0349	3.8483	0.0001
LAD-SI	50.45±4.25	50.10±4.11	0.97	0.33	48.1±5.20	49.1±5.10	2.22	0.0267	2.4786	<0.05
RAD-ML	40.32±6.45	39.87±6.33	0.81	0.42	40.48±6.23	40.14±6.17	0.63	0.5305	0.4962	0.6199
RAD-SI	46.87±3.11	47.09±3.07	0.82	0.41	46.88±3.06	47.12±3.12	0.90	0.3744	0.1114	0.9114

SRFT	Control group (n=266)				Treatment group (n=262)
SRFT	1 mon	12 mon	t	P	1 mon	12 mon	t	P
Serum creatinine (μmol/L)	88.75±18.03	87.59±17.97	0.7432	0.4577	87.53±17.78	88.4±16.81	0.602	0.5474
Serum potassium (mmol/L)	4.09±0.24	4.10±0.30	0.4245	>0.05	4.08±0.25	4.11±0.29	1.2683	>0.05

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