Spironolactone Fails to Lower Heart Failure and Cardiovascular Deaths in Acute MI Patients: CLEAR SYNERGY trial
USA: Spironolactone administered to patients after percutaneous coronary intervention (PCI) for acute myocardial infarction does not reduce cardiovascular mortality or the incidence of various cardiovascular events, including new or worsening heart failure, findings from the CLEAR SYNERGY trial have shown.
The CLEAR SYNERGY trial has dealt a second setback to the 2x2 factorial design study. Following the disappointing results from the colchicine arm last month—where the anti-inflammatory agent failed to reduce major cardiovascular (CV) events after acute myocardial infarction (MI)—new findings from the spironolactone arm show a similar lack of impact.
Dr. Sanjit Jolly from Hamilton Health Sciences/Population Health Research Institute, Canada, presented the latest data at the American Heart Association (AHA) 2024 Scientific Sessions. These results were simultaneously published in the New England Journal of Medicine alongside the full colchicine trial results.
Despite hopes that a mineralocorticoid receptor antagonist (MRA) like spironolactone might show benefits where colchicine did not, the trial results were disappointing. Dr. Jolly referenced previous studies like EPHESUS, which demonstrated that eplerenone, another MRA, reduced all-cause mortality in patients with heart failure (HF) following MI. However, two other conflicting trials, REMINDER and ALBATROSS, left the potential benefits of early MRA use in modern settings unclear.
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