Coronary artery diseaseUsefulness of Matrix Metalloproteinase-9 Plasma Levels to Identify Patients With Preserved Left Ventricular Systolic Function After Acute Myocardial Infarction Who Could Benefit from Eplerenone
Section snippets
Methods
The present study was designed as an open-label, randomized, parallel-group, nonplacebo-controlled, clinical study. Consecutive patients with ST-segment elevation AMI were recruited if they fulfilled the following inclusion criteria: (1) AMI 1 day to 7 days before enrollment and no aldosterone antagonist treatment and (2) LV ejection fraction ≥40% by transthoracic echocardiography on day 7 after the index event. Exclusion criteria were use of potassium-sparing diuretics, serum creatinine
Results
From the initial 350 study participants, 47 patients were excluded because of lack of complete (baseline or follow-up) data monitoring criteria or withdrawal of consent (Figure 1). The remaining 303 patients (mean age 58 ± 11 years, 249 men) constituted the study group (201 patients on eplerenone, 102 not on eplerenone treatment). During the study, 27 patients in the eplerenone group (13%) discontinued the study medication. The reported drug discontinuation reasons are shown in Figure 1. In
Discussion
The findings of the present study suggest that in patients after AMI with preserved LV ejection fraction (≥40%), the clinical benefit of eplerenone against death from cardiovascular causes, hospitalization for nonfatal reinfarction or unstable angina, or development of heart failure symptoms may be confined to patients with low baseline MMP-9 levels. Furthermore, use of eplerenone in this subgroup of patients was associated with a significant increase in MMP-9 levels. According to our
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