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Am Heart J：盐皮质激素拮抗剂对所有MI患者都有获益？

2018-01-24 安雅晶 环球医学网

盐皮质激素拮抗剂MI患者
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尽管急性心肌梗死（MI）的治疗已经取得了显着进展，但其结局和预后仍存在显着的发病率和死亡率。2018年1月，发表在《Am Heart》的一项meta分析，考察了盐皮质激素拮抗剂（MRAs）对所有MI患者的获益情况。

尽管急性心肌梗死（MI）的治疗已经取得了显着进展，但其结局和预后仍存在显着的发病率和死亡率。2018年1月，发表在《Am Heart》的一项meta分析，考察了盐皮质激素拮抗剂（MRAs）对所有MI患者的获益情况。

背景：尽管MRAs可减少心力衰竭合并MI患者的死亡率，但它们是否能使所有MI患者获益尚不清楚。该系统评价和meta分析，旨在评估MI患者中MRAs的效用。

方法：研究人员检索了1965年~2016年6月的MEDLINE、EMBASE和Cochrane CENTRAL以及2000年~2016年6月的会议摘要。其中评估了MIs后MRA效果的随机临床试验被纳入该分析。两名评审者独立提取了数据并评估了研究质量。采用固定/随机效应模型进行了数据汇总。

结果：11项随机临床试验（N=11258）被纳入；其中1项试验（N=6642）纳入了明显的心力衰竭患者（Killip class III-IV）。MI后MRA治疗vs安慰剂或标准治疗（无MRA）降低了总体和心血管死亡率（分别是，比值比[OR] 0.82，95%CI[置信区间]，0.73-0.93，P=0.002；OR 0.82，95%CI，0.71-0.93，P=0.003，两者I2均=0）。在心力衰竭患者的亚组试验中，MRA组vs无MRA组的死亡率分别为14.4%和16.7%（OR 0.84，95%CI，0.73-0.96）；在无心力衰竭的患者当中，MRA组vs无MRA组的死亡率为2.5%与3.5%（OR 0.72，95%CI，0.51-1.02，P=0.43）。接受MRA的患者很少出现新的或更严重的心衰事件（OR 0.74，95%CI，0.66-0.84，P＜0.0001；I2=14%）。但是，MRA疗法增加了高钾血症的风险（≥5.5mmol/L）（OR 2.52，95%CI，1.36-4.65，P=0.003，I2=63%）。

结论：急性MI后，MRA的治疗可减少死亡率，但这很大程度上是基于MI后合并心力衰竭的患者。对于无心力衰竭的MI患者需要进一步的数据。

在此次随机试验的meta分析中，11258例接受MRA或无MRA治疗的MI患者中，研究人员发现左心室的功能和尺寸有显着改善，并且总体的心血管死亡率以及心力衰竭住院率降低。然而，这些发现很大程度上是由EPHESUS的试验结果（其中89%的事件被纳入了当前的meta分析当中）所驱动的，这要求患者要么患有心力衰竭，要么患有左心室功能障碍合并糖尿病。MRA疗法也与更高的高钾血症风险（≥5.5mmol/L）相关。该meta分析表明，无心力衰竭的患者中存在MRA的潜在获益，但这些发现没有显着的统计学意义，仍需要进行大规模的随机临床试验来确定这一潜在的获益。

原始出处：
Bossard M, Binbraik Y, Beygui F,et al.Mineralocorticoid receptor antagonists in patients with acute myocardial infarction - A systematic review and meta-analysis of randomized trials.Am Heart J. 2018 Jan;195:60-69. doi: 10.1016/j.ahj.2017.09.010. Epub 2017 Sep 15.

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    2018-01-26 zhaojie88

    #ART#

    0

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    2018-01-26 ms5236388012055669

    #拮抗剂#

    0

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    2018-01-26 slcumt

    #HEART#

    0

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    2018-01-26 bbwznl

    #皮质激素#

    0

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    2018-01-24 1e0f8808m18(暂无匿称)

    学习了.谢谢分享

    0

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    2018-01-24 sunfeifeiyang

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