Effects of mineralocorticoid receptor antagonists on new-onset or recurrent atrial fibrillation: a Bayesian and frequentist network meta-analysis of randomized trials.

Autor: Karakasis P; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece. Electronic address: pakar15@hotmail.com., Patoulias D; Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece., Popovic DS; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia., Pamporis K; Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Theofilis P; First Cardiology Department, General Hospital of Athens 'Hippocratio', University of Athens Medical School, Athens, Greece., Nasoufidou A; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece., Stachteas P; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece., Samaras A; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece., Tzikas A; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece; European Interbalkan Medical Center, Department of Cardiology, Thessaloniki, Greece., Giannakoulas G; First Department of Cardiology, Aristotle University Medical School, Thessaloniki, AHEPA University General Hospital, Greece., Stavropoulos G; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece., Kassimis G; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece., Karamitsos T; First Department of Cardiology, Aristotle University Medical School, Thessaloniki, AHEPA University General Hospital, Greece., Fragakis N; Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece.
Jazyk: angličtina
Zdroj: Current problems in cardiology [Curr Probl Cardiol] 2024 Sep; Vol. 49 (9), pp. 102742. Date of Electronic Publication: 2024 Jul 15.
DOI: 10.1016/j.cpcardiol.2024.102742
Abstrakt: Background Clinical and translational research suggests that mineralocorticoid receptor antagonists (MRAs) may prevent atrial fibrosis and electrical remodeling associated with atrial fibrillation (AF). This study aimed to consolidate existing evidence from randomized controlled trials (RCTs) evaluating the effect of MRAs on incident or recurrent AF. Methods Medline, Cochrane Library and Scopus were searched until February 12, 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using both pairwise and Bayesian and frequentist network meta-analyses. Results Twenty-three RCTs (13,358 participants) were identified. Based on the pairwise random effects meta-analysis, MRAs were associated with a significant reduction in AF events compared to placebo or usual care (risk ratio {RR}= 0.75; 95% confidence interval {CI}= [0.66, 0.87]; P< 0.001; I 2 = 3%). This protective effect was robust both for new-onset and recurrent AF episodes (subgroup p-value= 0.69), while the baseline HF status was not a significant effect modifier (subgroup p-value= 0.58). MRAs demonstrated a significantly higher reduction in AF events for patients with chronic renal disease compared to placebo (RR= 0.78; 95% CI= [0.62, 0.98]; P= 0.03; I 2 = 0%). The network meta-analyses revealed that only spironolactone was associated with a significant reduction in AF events (Bayesian RR= 0.76; 95% CI= [0.65, 0.89]; P< 0.001; level of evidence moderate; SUCRA 0.731), while eplerenone and finerenone showed a neutral effect. Conclusion MRAs confer a significant benefit in terms of reducing incident or recurrent AF episodes, irrespective of HF status. In this context, spironolactone may be preferable compared to eplerenone or finerenone.
Competing Interests: Declaration of competing interest All authors declare no conflicts of interest.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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