Open AccessEffect of Mineralocorticoid Receptor Antagonists on the Prognosis of Patients with Ventricular Tachyarrhythmias
Author(s) -
Tobias Schupp,
Max von Zworowsky,
Linda Reiser,
Mohammad Abumayyaleh,
Kathrin Weidner,
Kambis Mashayekhi,
Thomas Bertsch,
Mohammed Abba,
İbrahim Akın,
Michael Behnes
Publication year - 2021
Publication title -
pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.51
H-Index - 59
eISSN - 1423-0313
pISSN - 0031-7012
DOI - 10.1159/000520310
Subject(s) - medicine , hazard ratio , cardiology , ejection fraction , clinical endpoint , heart failure , mineralocorticoid receptor , sudden cardiac death , aldosterone , confidence interval , randomized controlled trial
The study sought to assess the effect of treatment with mineralocorticoid receptor antagonists (MRAs) on long-term prognosis of patients with systolic heart failure (HF) surviving index episodes of ventricular tachyarrhythmias. Methods: A large retrospective registry was used including consecutive HF patients with left ventricular ejection fraction <45% and index episodes of ventricular tachyarrhythmias from 2002 to 2015. The primary endpoint was all-cause mortality at 3 years and secondary endpoints were rehospitalization, as well as the composite endpoint consisting of recurrent ventricular tachyarrhythmias, sudden cardiac death and appropriate implantabe cardioverter defibrillator (ICD) therapies at 3 years. Results: 748 patients were included, 20% treated with MRA and 80% without. At 3 years, treatment with MRA was not associated with improved all-cause mortality (22% vs. 24%, log-rank p = 0.968; hazard ratio (HR) = 1.008; 95% CI 0.690–1.472; p = 0.968). Accordingly, risk of the composite endpoint (28% vs. 27%; HR = 1.131; 95% CI 0.806–1.589; p = 0.476) and first cardiac rehospitalization (24% vs. 22%; HR = 1.139; 95% CI 0.788–1.648; p = 0.489) were not affected by treatment with MRA. Conclusion: In patients with ventricular tachyarrhythmias, treatment with MRA was not associated with improved all-cause mortality at 3 years. The therapeutic effect of MRA treatment in patients with ventricular tachyarrhythmias needs to be reinvestigated within further randomized controlled trials.