López-de-Sá Esteban, Martínez Angel, Anguita Manuel, Dobarro David, Jiménez-Navarro Manuel
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
Rev Esp Cardiol. 2011 Nov;64(11):981-7. doi: 10.1016/j.recesp.2011.06.013. Epub 2011 Sep 15.
Although of proven effectiveness, there are no data available on the patterns of aldosterone antagonists use in the setting of acute myocardial infarction.
The REICIAM registry is a prospective study designed to provide data regarding the incidence and management of heart failure after acute myocardial infarction. The aim of the present analysis was to determine the patterns of aldosterone antagonists use in this situation.
From a total of 2703 patients with acute myocardial infarction, 416 (15.4%) were considered optimal candidates to receive aldosterone antagonists, but only 228 (54.8%) received the treatment. The independent factors associated with their administration were male sex (odds ratio=2.06; 95% confidence interval, 1.23-3.49; P=.006), absence of prior kidney failure (odds ratio=3.31; 95% confidence interval, 1.26-9.06; P=.02), presentation with ST elevation (odds ratio=2.01; 95% confidence interval, 1.21-3.35; P=.007) and the development of malignant arrhythmias (odds ratio=2.75; 95% confidence interval, 1.3-6.05; P=.009). The lower the ejection fraction, the higher the likelihood of receiving aldosterone antagonists. The major independent predictor for receiving aldosterone antagonists was the prescription of diuretics during hospitalization (odds ratio=7.11; 95% confidence interval, 3.72-14.23; P <.00001), but also treatment with clopidogrel, beta-blockers, and statins. Although patients treated with aldosterone antagonists had a higher risk profile, they had a better 30-day survival rate than untreated patients (88.3% and 77.7% respectively; P <.0001).
The use of aldosterone antagonists in post-acute myocardial infarction is only 54.8% of the optimal candidates. Their use is associated with male sex, a higher risk profile, and the use of diuretics and other drugs of proven efficacy in secondary prevention.
尽管醛固酮拮抗剂已被证明有效，但在急性心肌梗死情况下其使用模式尚无可用数据。
REICIAM注册研究是一项前瞻性研究，旨在提供有关急性心肌梗死后心力衰竭发病率及管理的数据。本分析的目的是确定这种情况下醛固酮拮抗剂的使用模式。
在总共2703例急性心肌梗死患者中，416例（15.4%）被认为是接受醛固酮拮抗剂的最佳候选者，但只有228例（54.8%）接受了治疗。与其给药相关的独立因素为男性（比值比=2.06；95%置信区间，1.23 - 3.49；P = 0.006）、无既往肾衰竭（比值比=3.31；95%置信区间，1.26 - 9.06；P = 0.02）、ST段抬高表现（比值比=2.01；95%置信区间，1.21 - 3.35；P = 0.007）以及恶性心律失常的发生（比值比=2.75；95%置信区间，1.3 - 6.05；P = 0.009）。射血分数越低，接受醛固酮拮抗剂的可能性越高。接受醛固酮拮抗剂的主要独立预测因素是住院期间使用利尿剂（比值比=7.11；95%置信区间，3.72 - 14.23；P < 0.00001），但也包括使用氯吡格雷、β受体阻滞剂和他汀类药物。尽管接受醛固酮拮抗剂治疗的患者风险特征更高，但他们的30天生存率高于未治疗患者（分别为88.3%和77.7%；P < 0.0001）。
急性心肌梗死后醛固酮拮抗剂的使用仅占最佳候选者的54.8%。其使用与男性、更高的风险特征以及在二级预防中使用利尿剂和其他已证实有效的药物有关。
