LIVE from ESC: No benefit with aldosterone antagonists in acute myocardial infarction


In the ALBATROSS study, which was presented at the ESC Congress this morning, adding aldosterone to standard therapy in patients with acute myocardial infarction was not associated with a significant reduction in the primary outcome (which included death, resuscitated cardiac arrest, and significant ventricular arrhythmia). However, there was some indication of a reduction in mortality with aldosterone in patients with ST-segment elevation myocardial infarction (STEMI).

Presented at the ESC by Gilles Montalescot (Paris, France), ALBATROSS evaluated the effects of prolonged aldosterone antagonist therapy initiated early after the onset of myocardial infarction. Previous studies have indicated that aldosterone antagonists reduce mortality in myocardial infarction patients with heart failure. Therefore, the aim of the study was to determine if a similar effect would be seen in patients without heart failure – most of the patients in ALBATROSS did not have the condition.

In the study, 1,622 patients were randomised to standard therapy alone (801) or to standard therapy plus aldosterone antagonist therapy (802). The primary outcome was a combined endpoint of death, resuscitated cardiac arrest, significant ventricular arrhythmia, new indication for an ICD, or new or worsening heart failure at six months. At 118 days, the rate of the primary endpoint was similar between groups: 11.8% for the treatment group vs. 12.2% for the control group. However, a subgroup analysis found that aldosterone antagonist therapy was associated with a significant reduction in mortality in patients with STEMI.

Montalescot comments: “Our results suggest that heart failure is the main factor for the favourable effect of aldosterone antagonist therapy previously observed in myocardial infarction patients. In myocardial infarction patients without heart failure, we observed no benefit. We suggest to respect the current indication driven by heart failure.” He adds that the subgroup analysis produced an “intriguing, hypothesis-generating finding, which needs to be examined further in adequately-sized trials specifically dedicated to STEMI patients.”