Left ventricular systolic dysfunction (LVSD) is a common complication of acute
myocardial infarction (AMI) that occurs in approximately 30% of post-AMI patients, and results in a threefold increase in in-hospital and 6-month mortality, regardless of type of AMI. Post-AMI care has evolved to include early reperfusion, antiplatelet
therapy, hydroxymethylglutaryl
coenzyme A reductase inhibitors (stains), beta blockers, angiotentsin-converting
enzyme inhibitors, and
angiotensin receptor blockers. Despite these
therapies, however, there is still an excess of
sudden cardiac death (SCD), especially in patients with severe LVSD and in the first 30 days post-AMI.
Aldosterone has been shown to be elevated in patients with post-AMI LVSD and to have deleterious effects on the myocardium, including endothelial dysfunction,
collagen deposition,
inflammation, apoptosis, and autonomic instability, leading to
left ventricular remodeling and SCD.
Aldosterone blockade with
eplerenone has been shown to reduce mortality even in the presence of optimal post-AMI
therapy in patients with post-AMI LVSD. Despite this,
eplerenone is underutilized in real-world clinical practice. Care must be taken to follow renal function and
potassium balance in patients treated with
eplerenone.