48 Wu et al
World J Emerg Med, Vol 4, No 1, 2013
Original Article
Effect of spironolactone on cardiac remodeling after acute myocardial infarction Chun-tao Wu1, Zhong-hua Wang2, Zhu-qin Li2, Lan-feng Wang2 1 2
Department of Cardiology, Second Affiliated Hospital, Qiqihar Medical College, Qiqihar 161006, China CCU, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
Corresponding Author: Lan-feng Wang, Email: [email protected]
BACKGROUND: Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI. METHODS: A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up. RESULTS: The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LADSI were significantly improved in the treatment group compared with the control group at one year (P5.0 mmol/L; 7) the time from onset to admission longer than 24 hours; 8) age of more than 75 years. Groups All patients were randomly divided into a control group (n=308) with standard therapy and a treatment group
49
(n=308) with standard therapy plus oral administration of spironolactone 20 mg per day for one year, and administration of spironolactone after admission to the hospital within 17.1±3.8 hours. Standard therapy was prescribed with one-year oral administration of clopidogrel, aspirin, statins, β-blocker, angiotension converting enzyme inhibitors, and angiotensin II receptor blocker. The patients were followed up for one month and one year from onset respectively. During the followup, 26 patients (10 patients in the treatment group and 16 in the control group) died. Eight patients died from acute cerebrovascular disease, 10 from gastrointestinal bleeding, 4 from cancer, and 4 from traffic accidents. Twenty-five patients were lost to follow-up, 30 had reinfarction, and 7 male patients were withdrown from treatment because they were tolerable to breast pain. Therefore, only 528 patients were observed and treated completely within one year, with 266 in the control group and 262 in the treatment group. Between the two groups, there was no significant difference in age, gender, medical history, admission status, and treatment (Table 1).
Data collection During the follow-up, those who died, were lost to follow-up, had re-infarction, or completed the treatment because of side-effect after administration of
Table 1. Characteristics of the study population at baseline Variables Control group (n=266) Treatment group (n=262) Age (y) 59.9±10.3 59.8±11.7 Male/Female 192/74 193/69 Past medical history (n, %) Hypertension 117 (44) 123 (47) Diabetes mellitus 53 (20) 50 (19) Hypercholesterolemia 85 (32) 76 (29) Current smoker 136 (51) 141 (54) Earlier angina 64 (24) 60 (23) Admission state (n, %) Heart failure 4 (1.5) 4 (1.4) Blood pressure (mmHg) Systolic 118.3±9.8 117.2±10.3 Diastolic 72.5±5.5 73.2±5.7 Infarction location (n, %) Anterior wall (±lateral wall) 140 (52.6) 137 (52.3) Inferior wall (±posterior wall) 126 (47.4) 125 (47.7) Baseline therapies (n, %) Thrombolysis 76 (28.5) 79 (30) PCI 99 (37.4) 116 (44.1) Time from symptom onset to recanalization (h) 5.8±3.1 5.4±2.9 No recanalization treatment 93 (35) 100 (38) Standard therapy (n, %) ACEI / ARB 250 (94) 246 (94) Beta-blockers 247 (93) 247 (99) Statins 247 (92.9) 246 (93.9) Aspirin 261 (98.2) 258 (98.3) Clopidogrel 250 (94) 252 (96) Time from AMI to study drug (h) — 17.1±3.8 ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker.
t /χ2 0.1042 0.1471
P >0.05 0.7013
0.4669 0.0594 0.5410 0.3827 0.0987
0.4944 0.8074 0.4620 0.5362 0.7534
0.1120
0.7379
1.2573 1.4361
0.2092 0.1516
0.0062 0.0062
0.9374 0.9374
0.1591 2.7230 1.5306 0.5848
0.6900 0.0989 0.1265 0.4444
0.0020 0.4403 0.2289 0.0005 1.3624 —
0.9647 0.5070 0.6324 0.9817 0.2431 —
www.wjem.org
50 Wu et al
World J Emerg Med, Vol 4, No 1, 2013
spironolactone, were excluded from the study. The effect of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year followup, respectively. Echocardiographic indicators included left ventricular end-diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF), left atrial transverse diameter (LAD-ML), left atrial vertical diameter (LAD-SI), right atrial transverse diameter (RAD-ML), and right atrial vertical diameter (RAD-SI).
Statistical analysis Statistical analysis was performed using the PASW 18.0 statistical software. The data were presented as mean±standard deviation. The differences in the intragroup and inter-group were determined using Student's t test for variance nonhomogeneity. The categorical data were performed using the Chi-square test. P
World J Emerg Med, Vol 4, No 1, 2013
Original Article
Effect of spironolactone on cardiac remodeling after acute myocardial infarction Chun-tao Wu1, Zhong-hua Wang2, Zhu-qin Li2, Lan-feng Wang2 1 2
Department of Cardiology, Second Affiliated Hospital, Qiqihar Medical College, Qiqihar 161006, China CCU, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
Corresponding Author: Lan-feng Wang, Email: [email protected]
BACKGROUND: Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI. METHODS: A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up. RESULTS: The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LADSI were significantly improved in the treatment group compared with the control group at one year (P5.0 mmol/L; 7) the time from onset to admission longer than 24 hours; 8) age of more than 75 years. Groups All patients were randomly divided into a control group (n=308) with standard therapy and a treatment group
49
(n=308) with standard therapy plus oral administration of spironolactone 20 mg per day for one year, and administration of spironolactone after admission to the hospital within 17.1±3.8 hours. Standard therapy was prescribed with one-year oral administration of clopidogrel, aspirin, statins, β-blocker, angiotension converting enzyme inhibitors, and angiotensin II receptor blocker. The patients were followed up for one month and one year from onset respectively. During the followup, 26 patients (10 patients in the treatment group and 16 in the control group) died. Eight patients died from acute cerebrovascular disease, 10 from gastrointestinal bleeding, 4 from cancer, and 4 from traffic accidents. Twenty-five patients were lost to follow-up, 30 had reinfarction, and 7 male patients were withdrown from treatment because they were tolerable to breast pain. Therefore, only 528 patients were observed and treated completely within one year, with 266 in the control group and 262 in the treatment group. Between the two groups, there was no significant difference in age, gender, medical history, admission status, and treatment (Table 1).
Data collection During the follow-up, those who died, were lost to follow-up, had re-infarction, or completed the treatment because of side-effect after administration of
Table 1. Characteristics of the study population at baseline Variables Control group (n=266) Treatment group (n=262) Age (y) 59.9±10.3 59.8±11.7 Male/Female 192/74 193/69 Past medical history (n, %) Hypertension 117 (44) 123 (47) Diabetes mellitus 53 (20) 50 (19) Hypercholesterolemia 85 (32) 76 (29) Current smoker 136 (51) 141 (54) Earlier angina 64 (24) 60 (23) Admission state (n, %) Heart failure 4 (1.5) 4 (1.4) Blood pressure (mmHg) Systolic 118.3±9.8 117.2±10.3 Diastolic 72.5±5.5 73.2±5.7 Infarction location (n, %) Anterior wall (±lateral wall) 140 (52.6) 137 (52.3) Inferior wall (±posterior wall) 126 (47.4) 125 (47.7) Baseline therapies (n, %) Thrombolysis 76 (28.5) 79 (30) PCI 99 (37.4) 116 (44.1) Time from symptom onset to recanalization (h) 5.8±3.1 5.4±2.9 No recanalization treatment 93 (35) 100 (38) Standard therapy (n, %) ACEI / ARB 250 (94) 246 (94) Beta-blockers 247 (93) 247 (99) Statins 247 (92.9) 246 (93.9) Aspirin 261 (98.2) 258 (98.3) Clopidogrel 250 (94) 252 (96) Time from AMI to study drug (h) — 17.1±3.8 ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker.
t /χ2 0.1042 0.1471
P >0.05 0.7013
0.4669 0.0594 0.5410 0.3827 0.0987
0.4944 0.8074 0.4620 0.5362 0.7534
0.1120
0.7379
1.2573 1.4361
0.2092 0.1516
0.0062 0.0062
0.9374 0.9374
0.1591 2.7230 1.5306 0.5848
0.6900 0.0989 0.1265 0.4444
0.0020 0.4403 0.2289 0.0005 1.3624 —
0.9647 0.5070 0.6324 0.9817 0.2431 —
www.wjem.org
50 Wu et al
World J Emerg Med, Vol 4, No 1, 2013
spironolactone, were excluded from the study. The effect of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year followup, respectively. Echocardiographic indicators included left ventricular end-diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF), left atrial transverse diameter (LAD-ML), left atrial vertical diameter (LAD-SI), right atrial transverse diameter (RAD-ML), and right atrial vertical diameter (RAD-SI).
Statistical analysis Statistical analysis was performed using the PASW 18.0 statistical software. The data were presented as mean±standard deviation. The differences in the intragroup and inter-group were determined using Student's t test for variance nonhomogeneity. The categorical data were performed using the Chi-square test. P
