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1、在急性心梗后服用依普利酮有助于改善心血管预后SAN FRANCISCO 研究者指出，早期服用醛固酮受体拮抗剂（依普利酮）有助于改善没有心衰的 st 段抬高性心肌梗死患者的预后在接下来平均10 个半月的随访过程中，心血管死亡率，心衰，以及主要复合心血管终点事件的其他方面的发生率在依普利酮组为18.4 , 而安慰组的发生率为29.6 ， (HR 0.58; 95 CI 0.45 to 0.75; P5.5mmol/L ）在依普利酮组患者中发生率为5.6 ，相比较安慰组为 3.2 (P=0.09) 低钾血症（血清钾离子3.5mmol/L ）在普利酮组患者中发生率为在1.4 ，而安慰组为5.6 (P=
2、0.0002). 在两组中有一共有59患者发生不良事件，在普利酮组患者因不良事件而停药发生率为 5.5 ，而安慰组为4.8 ，没有统计学意义，在两组中有3 例患者死亡。威尔康奈尔医学院和这次科学会议主席Miguel Quinones博士在评论这一发现指出，对于有或没有正常射血分数的心肌梗死患者而言，评价短期和长期预后中，B型利钠肽 (BNP)/NT-proBNP 被证明是一个重要的生物标志。Quinones 表示只有这个方法展示其能改善临床预后，否则这些发现就必须在假设条件下对待。短期结果是显著的，如果我们能看到5 年后患者预后的改善，这会是一次革新。他表示不断进行的在大规模人群进行的这个假设
3、调查的ALBATROSS 研究，应该会给出一些答案。英文原文：ACC: Inspra Aids CV Outcomes After Acute MI SAN FRANCISCO - Early administration of the aldosterone blocker eplerenone(Inspra) may help to improve cardiovascular outcomes in patients presenting with acute ST-segment elevated myocardial infarction (STEMI) without preexi
4、sting heart failure, researchers reported here After a mean follow-up of 10.5 months, the rate of CV mortality, heart failure and other components of the primary composite cardiovascular endpoint was 18.4 in the eplerenone group compared with 29.6 in the placebo group (HR 0.58; 95 CI 0.45 to 0.75; P
5、0.0001), according to Gilles Montalescot, MD, of theInstitute of Cardiology at Centre Hospitalier Piti - Salptri re in Paris, and colleagues. In the 1,012-patient trial, the composite endpoint was defined as the time to cardiovascular mortality, hospitalization or extended initial hospital stay due
6、to diagnosis of heart failure, sustained ventricular tachycardia or fibrillation, ejection fraction (EF) 40 after 1 month, or an elevation of B-type natriuretic peptide (BNP)/NT-proBNP after 1 month, they reported at the annual scientific session of the American College of Cardiology. “The improveme
7、nt in outcome was driven mainly by a significant reduction insubclinical heart failure, with BNP elevations occurring in 16 of the eplerenone group versus 25.9 of the placebo group at 1 month (adjusted HR 0.584, CI0.441 to 0.773; P0.0002),“ said Montalescot. The REMINDER (Reduction of heart failure
8、morbidity in patients with acute ST-elevation myocardial infarction) trial was presented during a late-breaker session at the meeting. “REMINDER is the first randomized trial to test a mineralocorticoid receptor agonist during the acute phase of heart attack, and the results suggest a clinical benef
9、it,“ Montalescot said. He noted that the study population was low-risk, with a mortality rate of only 0.4. “Despite this, a benefit was observed with eplerenone to prevent adverse outcomes and subclinical heart failure,“ Montalescot said. In the trial, STEMI patients were randomized in a 1:1 fashion
10、 to once-dailyeplerenone (25 to 50 mg) or placebo, plus standard of care medications. Treatment was initiated within the first 24 hours of symptom onset and preferably within first 12 hours. More than 98 of patients in both groups were on acetylsalicylic acid and P2Y12 antagonists, and nearly 80 wer
11、e on heparin or fondaparinux. A total of 85.3 of patients in the eplerenone group and 86.9 in the placebo group had undergone primary percutaneous coronary intervention Subgroups analyses showed that patients on eplerenone fared better regardless of sex, age, systolic blood pressure, heart rate, and
12、 other factors. As for safety, significantly more patients in the eplerenone group had hyperkalemia, but the overall rate of adverse events was similar in both groups: Hyperkalemia (serum potassium levels over 5.5 mmol/L) occurred in 5.6 of patients in the eplerenone group versus 3.2 in the placebo
13、groups (P=0.09). Hypokalemia (serum potassium levels below 3.5 mmol/L) occurred in 1.4 of patients in the eplerenone group versus 5.6 in the placebo group (P=0.0002). A total of 59 of patients in both groups experienced an adverse event. Adverse events leading to drug discontinuation occurred in 5.5
14、 of patients inthe eplerenone group and 4.8 in the placebo group, a nonsignificant difference. There were three deaths in both groups. Commenting on the findings, Miguel Quinones, MD, of Weill Cornell Medical College and scientific chair of the meeting, noted that B-type natriuretic peptide (BNP)/NT
15、-proBNP has been shown to be an important biomarker for short- and long-term prognosis in patients with myocardial infarction in the presence or absence of preserved ejection fraction. Nonetheless, until the approach has been shown to improve clinical outcomes,the findings must be viewed as hypothes
16、is-generating, Quinones said. “The short-term results are striking,“ he said. “If we see improved outcomes 5 years down the road, it could be a game-changer.“ He noted that the ongoing ALBATROSS Aldosterone Blockade Early After AcuteMyocardial Infarction study, which is investigating this hypothesis in a larger population, should offer some answers
