Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece.
Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece.
Curr Probl Cardiol. 2024 Sep;49(9):102742. doi: 10.1016/j.cpcardiol.2024.102742. Epub 2024 Jul 15.
Background Clinical and translational research suggests that mineralocorticoid receptor antagonists (MRAs) may prevent atrial fibrosis and electrical remodeling associated with atrial fibrillation (AF). This study aimed to consolidate existing evidence from randomized controlled trials (RCTs) evaluating the effect of MRAs on incident or recurrent AF. Methods Medline, Cochrane Library and Scopus were searched until February 12, 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using both pairwise and Bayesian and frequentist network meta-analyses. Results Twenty-three RCTs (13,358 participants) were identified. Based on the pairwise random effects meta-analysis, MRAs were associated with a significant reduction in AF events compared to placebo or usual care (risk ratio {RR}= 0.75; 95% confidence interval {CI}= [0.66, 0.87]; P< 0.001; I= 3%). This protective effect was robust both for new-onset and recurrent AF episodes (subgroup p-value= 0.69), while the baseline HF status was not a significant effect modifier (subgroup p-value= 0.58). MRAs demonstrated a significantly higher reduction in AF events for patients with chronic renal disease compared to placebo (RR= 0.78; 95% CI= [0.62, 0.98]; P= 0.03; I= 0%). The network meta-analyses revealed that only spironolactone was associated with a significant reduction in AF events (Bayesian RR= 0.76; 95% CI= [0.65, 0.89]; P< 0.001; level of evidence moderate; SUCRA 0.731), while eplerenone and finerenone showed a neutral effect. Conclusion MRAs confer a significant benefit in terms of reducing incident or recurrent AF episodes, irrespective of HF status. In this context, spironolactone may be preferable compared to eplerenone or finerenone.
背景:临床和转化研究表明,盐皮质激素受体拮抗剂(MRAs)可能预防与心房颤动(AF)相关的心房纤维化和电重构。本研究旨在整合评估 MRA 对新发或复发性 AF 影响的随机对照试验(RCTs)的现有证据。
方法:检索 Medline、Cochrane 图书馆和 Scopus,截至 2024 年 2 月 12 日。进行三重独立的研究选择、数据提取和质量评估。使用成对和贝叶斯及频率论网络荟萃分析来汇总证据。
结果:共确定了 23 项 RCT(13358 名参与者)。基于成对随机效应荟萃分析,与安慰剂或常规护理相比,MRA 与 AF 事件的显著减少相关(风险比{RR}=0.75;95%置信区间{CI}=[0.66, 0.87];P<0.001;I=3%)。这种保护作用对新发和复发性 AF 发作均稳健(亚组 p 值=0.69),而基线 HF 状态不是显著的效应修饰因子(亚组 p 值=0.58)。与安慰剂相比,MRA 显著降低了慢性肾脏病患者的 AF 事件发生率(RR=0.78;95% CI=[0.62, 0.98];P=0.03;I=0%)。网络荟萃分析显示,只有螺内酯与 AF 事件的显著减少相关(贝叶斯 RR=0.76;95% CI=[0.65, 0.89];P<0.001;证据水平中等;SUCRA 0.731),而依普利酮和非奈利酮显示中性效应。
结论:MRA 可显著降低新发或复发性 AF 发作的风险,与 HF 状态无关。在这种情况下,与依普利酮或非奈利酮相比,螺内酯可能更可取。
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