Aldosterone Receptor Antagonist and Heart Failure Following Acute Myocardial Infarction

The presence of heart failure or LV systolic dysfunction in the setting of acute myocardial infarction is associated with poor prognosis. Aldosterone is an important downstream mediator of the renin-angiotensin-aldosterone system which, in the post-acute myocardial infarction setting, promotes myocardial collagen deposition, myocardial fibrosis, apoptosis, endothelial dysfunction, ventricular remodeling, and heart failure, with attendant increased morbidity and mortality. Extending the findings from the Randomized Aldactone Evaluation Study (RALES) in chronic heart failure patients, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) demonstrated that the selective aldosterone blocker eplerenone offered a significant survival benefit, attenuated the progression of heart failure, and prevented sudden cardiac death when used in addition to optimal medical therapy. The current evidence-based guidelines suggest that aldosterone blockade should be an integral component of heart failure therapy to improve outcomes in this high-risk population.