{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:58:28Z","timestamp":1790632708827,"version":"4.1.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,7,17]]},"abstract":"\n Background<\/jats:title>\n \n There are no studies of mineralocorticoid receptor antagonist (\n MRA<\/jats:styled-content>\n ) treatment examining outcome in unselected real\u2010life patients with myocardial infarction (\n MI<\/jats:styled-content>\n ) and heart failure (\n HF<\/jats:styled-content>\n ). There is uncertainty regarding effects of\n MRA<\/jats:styled-content>\n in relation to left ventricular ejection fraction (\n LVEF<\/jats:styled-content>\n ) and chronic kidney disease (\n CKD<\/jats:styled-content>\n ). The aim was to assess\n MRA<\/jats:styled-content>\n use and compare outcomes in\n MI<\/jats:styled-content>\n patients with\n HF<\/jats:styled-content>\n in relation to\n LVEF<\/jats:styled-content>\n and\n CKD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Patients with\n MI<\/jats:styled-content>\n and\n HF<\/jats:styled-content>\n registered in the Swedish myocardial infarction registry,\n SWEDEHEART<\/jats:styled-content>\n , 2005\u20132014, were included. Associations between\n MRA<\/jats:styled-content>\n use and all\u2010cause mortality up to 3\u00a0years were assessed with multivariable Cox regression, stratified by\n EF<\/jats:styled-content>\n groups and presence of\n CKD<\/jats:styled-content>\n (estimated glomerular filtration rate <60\u00a0mL\/min per 1.73\u00a0m\n 2<\/jats:sup>\n ). Of 45\u00a0071 patients with\n MI<\/jats:styled-content>\n and\n HF<\/jats:styled-content>\n , 4470 (9.9%) received\n MRA<\/jats:styled-content>\n . Those with\n HF<\/jats:styled-content>\n and\n LVEF<\/jats:styled-content>\n <40% more often had\n MRA<\/jats:styled-content>\n (19.6%) compared with those with\n LVEF<\/jats:styled-content>\n 40% to 49% (9.1%) or\n LVEF<\/jats:styled-content>\n \u226550% (4.7%). 8.6% of patients with\n CKD<\/jats:styled-content>\n received\n MRA<\/jats:styled-content>\n . After adjustment,\n MRA<\/jats:styled-content>\n use was associated with lower mortality in those with\n LVEF<\/jats:styled-content>\n <40% (hazard ratio [95% confidence interval] 0.81 [0.75\u20130.88]) and\n LVEF<\/jats:styled-content>\n 40% to 49% (0.88 [0.75\u20131.03]) but not in those with\n LVEF<\/jats:styled-content>\n \u226550% (1.29 [1.09\u20131.53]), with significant interaction between\n MRA<\/jats:styled-content>\n and\n LVEF<\/jats:styled-content>\n (\n P<\/jats:italic>\n <0.0001). The association between\n MRA<\/jats:styled-content>\n use and mortality was similar in those without (0.96 [0.88\u20131.05]) and with (0.92 [0.85\u20130.99])\n CKD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In patients with\n MI<\/jats:styled-content>\n and\n HF<\/jats:styled-content>\n ,\n MRA<\/jats:styled-content>\n use was associated with better long\u2010term survival in patients with\n LVEF<\/jats:styled-content>\n <40% but not in those with\n LVEF<\/jats:styled-content>\n \u226550%, while the mortality risk was similar in\n MRA<\/jats:styled-content>\n \u2010treated patients with or without\n CKD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.009359","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T09:21:29Z","timestamp":1530868889000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure"],"prefix":"10.1161","volume":"7","author":[{"given":"Ida","family":"L\u00f6fman","sequence":"first","affiliation":[{"name":"Unit of Cardiology, Heart and Vascular Theme, Huddinge Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Szummer","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Heart and Vascular Theme, Huddinge Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan\u2010Jesus","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Heart and Vascular Theme, Solna Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Jernberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Danderyd University Hospital Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw128"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2013.110"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030207"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.092"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013255"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht386"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2015-000324"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.03.066"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.198804"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hft128"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt312"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.06.020"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-016-0425-x"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.813"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2012.08.001"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11897-017-0325-0"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv464"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.821"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2004.04.011"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-11-1355"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.11.063"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2003.00929.x"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-016-1319-7"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.09.056"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.04.086"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.048"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000792"}],"updated-by":[{"DOI":"10.1161\/jaha.117.004268","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2019,2,14]],"date-time":"2019-02-14T00:00:00Z","timestamp":1550102400000}}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.009359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:07:59Z","timestamp":1715598479000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.009359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,17]]},"references-count":31,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2018,7,17]]}},"alternative-id":["10.1161\/JAHA.118.009359"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.009359","relation":{"correction":[{"id-type":"doi","id":"10.1161\/JAHA.117.004268","asserted-by":"object"}]},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,17]]},"assertion":[{"value":"2018-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e009359"}}