Mineralocorticoid receptor antagonist use in eligible patients following acute myocardial infarction: Real world data from the Acute Coronary Syndrome Israeli Surveys: 2004–2010

Abstract Background Following the EPHESUS trial in 2003, mineralocorticoid receptor antagonist (MRA) therapy received a class I indication for the management of eligible high-risk post-MI patients. Our goal was to examine temporal trends in MRA use in eligible post-myocardial infarction (MI) patients. Methods We investigated temporal trends and factors associated with MRA utilization among eligible patients enrolled in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) 2004–2010. Results Among 7696 patients enrolled in the ACSIS surveys from 2004, 955 (12%) were eligible for MRA therapy. In this population, prescription of MRAs at discharge from the index event showed a modest increase from 21% to 25% over the six-year period, whereas utilization of other guideline recommended drugs, including angiotensin converting enzyme inhibitors/receptor blockers and β-blockers was > 2-fold higher. Multivariate logistic regression analysis showed that independent predictors of MRA prescription at discharge included a higher degree of left ventricular dysfunction (LVEF ≤ 30% vs. 31–40%: OR = 2.19; p = 0.02), history of heart failure prior to admission (OR = 1.92; p < 0.004), admission Killip ≥ II (OR = 1.78; p = 0.004), and an anterior location of the index MI (OR = 1.54; p = 0.03). MRA utilization was not associated with an increased risk for adverse events or rehospitalization at 30 days of follow-up. Conclusions In a real world setting, approximately one quarter of eligible post-MI patients are treated with an MRA following the index event, without a significant time-dependent change in this management strategy. MRAs are more likely to be underutilized in eligible lower-risk patients.