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Comment & Response
November 2018

Mineralocorticoid Receptor Antagonism Treatment for All Patients With ST-Segment Myocardial Infarction?—Reply

Author Affiliations
  • 1Division of Cardiology, Louisiana State University Health Science Center, Shreveport
JAMA Intern Med. 2018;178(11):1567-1568. doi:10.1001/jamainternmed.2018.5964

In Reply We thank Dr Weir for his interest in our article.1 Although none of the individual trials showed statistically significant reduction in mortality except for ALBATROSS study,2 cumulative evidence supported the role of mineralocorticoid receptor antagonist (MRA) treatment in patients with acute ST-elevation myocardial infarction (STEMI) without heart failure or left ventricular ejection (LVEF) fraction greater than 40%. The findings of our meta-analysis are consistent with a recently published individual patient level analysis of 2 trials that evaluated MRA therapy in such patients.3 Although individual studies may be inconclusive, or show conflicting results, meta-analysis may help with cumulative analysis of available research in a topic of interest, which has been demonstrated in the past.4

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