MRA indication and underuse in high‐risk post myocardial infarction patients

MRA indication and underuse in high-risk post myocardial infarction patients. European Journal of Heart Failure, 2023, 10.1002/ejhf.3098. [...] “Sacubitril/valsartan compared to ramipril in high-risk post myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: Insight from PARADISE MI trial”1 published in the European Journal of Heart Failure. [...] The mineralocorticoid receptor antagonist (MRA) eplerenone has been shown to improve the prognosis of patients who had a myocardial infarction (MI) complicated with symptomatic left ventricular systolic dysfunction (LVSD) on top of angiotensin converting enzyme inhibitors (ACEi) in the landmark EPHESUS (Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) tria [...] In this regard, the PARADISE-MI (Prospective ARNI vs ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI) trial tested the efficacy and safety of sacubitril/valsartan vs ramipril in 5661 patients who had an MI (within 7 days) with LVSD. [...] add relevant information to the literature by assessing the efficacy and safety of sacubitril/valsartan vs ramipril according to MRA therapy in the PARADISE-MI trial.1 It is important to highlight that, despite being a guideline3 recommended therapy for patients who had an MI complicated with LVSD, in the global PARADISE-MI trial, only 41% of the patients were using MRAs at baseline (in cont [...] In conclusion, this report from the global PARADISE-MI trial reinforces that MRA are underused in contemporary patients with a clear indication for MRA therapy.1 Based on the best available evidence, it is important to stress out that eplerenone is recommended by international guidelines for the treatment of patients with MI and LVSD or HF, whereas sacubitril/valsartan is not.3 Still, the addi [...] Sacubitril/valsartan compared to ramipril in high-risk post myocardial infarction patients stratified according use of mineralocorticoid receptor antagonists: Insight from PARADISE MI trial. Eur J Heart Fail. 2023. doi: 10.1002/ejhf.3079 2. [...] Impact of Sacubitril/Valsartan Versus Ramipril on Total Heart Failure Events in the PARADISE-MI Trial. Circulation. 2022;145:87-89. doi: 10.1161/circulationaha.121.057429 10. [...] Why are mineralocorticoid receptor antagonists the Cinderella in evidence-based treatment of myocardial infarction complicated with heart failure? [...] Eplerenone in patients with myocardial infarction and "mid-range" ejection fraction: An analysis from the EPHESUS trial. Clin Cardiol. 2019;42:1106-1112.