[Effect of spironolactone on mortality in patients with severe left ventricular dysfunction after acute myocardial infarction].

Background: Spironolactone--non-selective mineralocroticoid receptor blocker in patients with chronic heart failure reduces the risk of death. Its efficacy was not assessed in patients with postinfarction (post-MI) left ventricular dysfunction. The purpose of this study was to evaluate the effect of spironolactone on mortality in survivors of acute myocardial infarction with depressed ejection fraction < 30% (EF%) during a 24-month, long-term observation.

Methods: Study population consisted of 47 patients, 38 men and 9 women aged 41-79 years, mean age 62 +/- 10 years with severe post-MI left ventricular dysfunction (EF% < 30%). Patients were divided into 2 groups according to applied treatment: the group spironolactone (+) - 22 pts who received spironolactone at daily dose 25-50 mg and the group spironolacton (-) - 25 pts not treated with spironolactone. The end point of this observation was mortality from all causes during a 24-month follow-up.

Results: During long-term observation - 19 of 47 patients died (40%). Mortality from all causes in the group spironolactone (+) - 11/22 (50%) was non significantly higher as compared to the group spironolactone (-) - 8/25 (32%).

Conclusion: In patients with severe left ventricular dysfunction (EF < 30%) after acute myocardial infarction long-term treatment with spironolactone at daily dose 25-50 mg does not reduce mortality rate in long-term follow-up.