Scientific Sessions 2024  /  Prevention of Injury and Improvement in Outcomes in the ACS Population  /  Mineralocorticoid receptor antagonist in patients with acute myocardial infarction: An updated systematic review and meta-analysis of randomized trials
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American Heart Association

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Final ID: MDP1709

Mineralocorticoid receptor antagonist in patients with acute myocardial infarction: An updated systematic review and meta-analysis of randomized trials

Abstract Body (Do not enter title and authors here): Background: While mineralocorticoid antagonists (MRA) reduce mortality in patients developing heart failure post myocardial infarction (MI), it is unclear whether they are beneficial in an unselected post-MI population.

Aims: Using a systematic review and meta-analysis, we aim to determine the effect of MRA treatment versus no MRA treatment on all-cause mortality in unselected post-MI patients from randomized data, simultaneously with the presentation of the largest randomized controlled trial on the topic, the CLEAR SYNERGY trial.

Methods/Approach: We completed a systematic review of all randomized controlled trials comparing MRA treatment to no MRA treatment in post-MI patients. We will perform our primary analysis using fixed effects with the Peto odds ratio method and use random effects as a sensitivity analysis. The primary outcome will be all-cause mortality, and secondary outcomes will include cardiovascular mortality, new or worsening heart failure, recurrent myocardial infarction and stroke.

Results/Data: Our systematic review of Pubmed, Embase, and CENTRAL from inception until April 30, 2024, yielded 456 records. A total of 11,199 participants from 11 randomized clinical trials will be included in addition to the late-breaking CLEAR SYNERGY trial. The CLEAR SYNERGY trial is a 2 x 2 factorial randomized controlled trial of low-dose colchicine 0.5mg daily versus placebo and spironolactone 25mg daily versus placebo in 7,062 post-MI patients who were within 72h of the index percutaneous coronary intervention. The results of the spironolactone factorial will be presented in the fall of 2024 with an expected median follow-up of 3.5 years. As the investigators of the CLEAR SYNERGY trial, we will combine our data with the other 11 trials for a total of 12 trials and 18,261 participants.

Conclusions: CLEAR SYNERGY is the largest randomized controlled trial with the longest follow-up of spironolactone in the post-MI population. Our meta-analysis will provide updated effect estimates of post-MI MRA treatment, leveraging the late-breaking CLEAR SYNERGY data to reflect the totality of the evidence.
  • D'entremont, Marc-andre  ( Population Health Research Institute , Hamilton , Ontario , Canada )
  • Montalescot, Gilles  ( HOPITAL PITIE SALPETRIERE , Paris , France )
  • Zannad, Faiez  ( CVCT and Universite de Lorraine , Paris , France )
  • Beygui, Farzin  ( CHU CAEN , Caen , France )
  • Pitt, Bertram  ( University of Michigan School , Ann Arbor , Michigan , United States )
  • Jolly, Sanjit  ( Population Health Research Institute , Hamilton , Ontario , Canada )
  • Cheema, Zain  ( McMaster University , Hamilton , Ontario , Canada )
  • Chauhan, Ashwin  ( McMaster University , Hamilton , Ontario , Canada )
  • Kedev, Sasko  ( University Clinic of Cardiology , Skopje , Macedonia (the former Yugoslav Republic of) )
  • Cornel, Jan  ( Radboudumc , Nijmegen , Netherlands )
  • Stankovic, Goran  ( Univ. Clinical Center of Serbia , Belgrade , Serbia )
  • Moreno, Raul  ( University Hospital La Paz, Madrid, , Madrid , Spain )
  • Storey, Robert  ( UNIVERSITY SHEFFIELD MEDICAL SCHOOL , Sheffield , United Kingdom )
  • Bossard, Matthias  ( Luzerner Kantonsspital , Luzerne , Switzerland )
    • Author Disclosures:
    Marc-Andre d'Entremont: DO NOT have relevant financial relationships | Gilles Montalescot: DO have relevant financial relationships ; Other (please indicate in the box next to the company name):Abbott : research or educational grant to the institution and consulting or lecture fees:Active (exists now) ; Other (please indicate in the box next to the company name):Terumo : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):SMT : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):Pfizer:Active (exists now) ; Other (please indicate in the box next to the company name):Novo Nordisk : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):Lilly:Past (completed) ; Other (please indicate in the box next to the company name):Idorsia:Active (exists now) ; Other (please indicate in the box next to the company name):Hexacath:Past (completed) ; Other (please indicate in the box next to the company name):CSL Behring : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):Celecor : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):Boehringer Ingelheim : research or educational grant to the institution and consulting or lecture fees:Active (exists now) ; Other (please indicate in the box next to the company name):BMS : research or educational grant to the institution and consulting or lecture fees:Active (exists now) ; Other (please indicate in the box next to the company name):Bayer : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):AstraZeneca : research or educational grant to the institution and consulting or lecture fees:Past (completed) ; Other (please indicate in the box next to the company name):Amgen : research or educational grant to the institution and consulting or lecture fees:Past (completed) | Faiez ZANNAD: DO have relevant financial relationships ; Advisor:NovoNordisk:Past (completed) ; Advisor:Northsea:Expected (by end of conference) ; Advisor:Merck:Active (exists now) ; Advisor:CEVA:Past (completed) ; Advisor:Cellprothera:Active (exists now) ; Advisor:Cereno:Active (exists now) ; Ownership Interest:CVCT:Active (exists now) ; Advisor:Cardior:Past (completed) ; Advisor:CVRx:Active (exists now) ; Advisor:BMS:Past (completed) ; Advisor:Boehringer:Active (exists now) ; Advisor:Biopeutics:Active (exists now) ; Consultant:Owkin:Active (exists now) ; Advisor:Bayer:Active (exists now) ; Advisor:Applied Therapeutics:Past (completed) | Farzin Beygui: No Answer | Bertram Pitt: No Answer | Sanjit Jolly: No Answer | Zain Cheema: DO NOT have relevant financial relationships | Ashwin Chauhan: No Answer | Sasko Kedev: DO NOT have relevant financial relationships | Jan Cornel: No Answer | Goran Stankovic: DO NOT have relevant financial relationships | Raul Moreno: No Answer | Robert Storey: DO have relevant financial relationships ; Consultant:AstraZeneca:Active (exists now) ; Speaker:Tabuk:Past (completed) ; Consultant:Pfizer:Past (completed) ; Consultant:Novo Nordisk:Active (exists now) ; Consultant:Novartis:Past (completed) ; Consultant:Idorsia:Active (exists now) ; Consultant:Daiichi Sankyo:Past (completed) ; Consultant:Chiesi:Past (completed) ; Consultant:Boehringer Ingelheim/Lilly:Past (completed) ; Consultant:Alfasigma:Past (completed) ; Researcher:Cytosorbents:Active (exists now) ; Consultant:Cytosorbents:Active (exists now) ; Researcher:AstraZeneca:Active (exists now) | Matthias Bossard: No Answer
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Prevention of Injury and Improvement in Outcomes in the ACS Population

Monday, 11/18/2024 , 12:50PM - 02:15PM

Moderated Digital Poster Session

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In-Depth: The CLEAR SYNERGY (OASIS 9) Trial: A 2x2 Factorial Randomized Controlled Trial of Colchicine versus placebo and Spironolactone versus placebo in Patients with Myocardial Infarction. The results of the spironolactone factorial

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Discussant: REALIZE-K

Zannad Faiez, Allen Larry

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