Aldosterone Antagonists For The Prevention Of Cardiac Death And Sudden Cardiac Death In Patients With Left Ventricular Dysfunction: A Meta-analysis

Background:Aldosterone antagonists had been suggested to protect against cardiac death in some studies but has remained inadequately explored.Objective:This meta-analysis was to identify the effects of aldosterone antagonists for the prevention of cardiac death and sudden cardiac death (SCD) in left ventricular (LV) dysfunction patients.Methods:A systemic literature search in MEDLINE, EMBASE, and Cochrane Central Trials Register (CCRT) was performed, and randomized trials involving the preventive effect of aldosterone antagonists for cardiac death were retrieved. Effect size was expressed as odds ratio (OR) with95%confidence interval (CI). Subgroup analysis and meta-regression were also performed to explore the influence of potential variables.Results:Ten trials with12813patients entered into this study. Overall, aldosterone antagonists were associated with a significantly reduced risk of cardiac death (OR,0.74;95%CI,0.65-0.83, P<0.00001) and SCD (OR,0.77;95%CI,0.66-0.90, P=0.001). The drug was effective in both the LVEF<30%(OR,0.63;95%CI,0.52-0.78) and LVEF≥30%(OR,0.79;95%CI,0.68-0.91) subgroup, however,no significant difference was identified between the subgroups (P=0.075). Moreover, beta-blockers as adjunctive therapy did not significantly reduce the risk of cardiac death (P=0.08941).Conclusions:This study suggested that aldosterone antagonists were useful for the prevention of both cardiac death and SCD in LV dysfunction patients. However, we failed to discover the significant influences of LVEF and beta-blockers for the benefit of aldosterone antagonists. The potential protective role of the drug against cardiac death deserves further evaluation.