Table 1.
Characteristics of MRA‐Eligible Patients With STEMI
| Characteristic |
Total MRA‐Eligible (n=317) |
No MRA at Discharge (n=247) |
MRA at Discharge (n=70) |
P Value |
|---|---|---|---|---|
| Age, mean (SD), y | 67.4 (12.9) | 67.9 (12.9) | 65.7 (12.5) | 0.214 |
| Female patients, n (%) | 68 (21.5) | 55 (22.3) | 13 (18.6) | 0.506 |
| BMI, mean (SD) | 27.0 (5.2) | 26.8 (5.2) | 27.8 (5.0) | 0.165 |
| STEMI admission details | ||||
| Anterior infarct, n (%) | 248 (78.2) | 193 (78.1) | 55 (78.6) | 0.938 |
| HF on presentation, n (%) | 59 (18.6) | 49 (19.8) | 10 (14.3) | 0.292 |
| Admitted to PCI‐capable hospital, n (%) | 216 (68.1) | 172 (69.6) | 44 (62.9) | 0.283 |
| PCI, n (%) | 310 (97.8) | 241 (97.6) | 69 (98.6) | 0.615 |
| Fibrinolysis only, n (%) | 7 (2.2) | 6 (2.4) | 1 (1.4) | 0.615 |
| In‐hospital HF, n (%) | 207 (65.3) | 151 (61.1) | 56 (80.0) | 0.003 |
| In‐hospital cardiac arrest, n (%) | 23 (12.9) | 12 (9.3) | 11 (22.4) | 0.020 |
| Unknown, n | 139 | 118 | 21 | |
| Hospital length‐of‐stay, median (IQR), d | 4.7 (3.2–8.3) | 4.5 (3.2–8.2) | 5.4 (3.3–9.8) | 0.593 |
| ≤3 d, n (%) | 64 (20.2) | 51 (20.6) | 13 (18.6) | 0.702 |
| Cardiovascular disease and risk factors, n (%) | ||||
| Diabetes mellitus | 151 (47.6) | 127 (51.4) | 24 (34.3) | 0.011 |
| Prior HF | 18 (5.7) | 12 (4.9) | 6 (8.6) | 0.236 |
| Prior MI | 72 (22.7) | 54 (21.9) | 18 (25.7) | 0.497 |
| Prior PCI | 48 (15.1) | 32 (13.0) | 16 (22.9) | 0.041 |
| Current/recent smoker | 69 (21.8) | 54 (21.9) | 15 (21.4) | 0.938 |
| Hypertension | 211 (66.6) | 164 (66.4) | 47 (67.1) | 0.907 |
| Dyslipidemia | 157 (49.5) | 122 (49.4) | 35 (50.0) | 0.929 |
| Clinical and laboratory values | ||||
| LVEF | ||||
| Mean (SD) | 32.6 (6.6) | 33.4 (6.4) | 29.5 (6.5) | <0.001 |
| Median (IQR) | 35 (30–38) | 35 (30–40) | 30 (25–35) | |
| ≤20%, n (%) | 38 (12.0) | 24 (9.7) | 14 (20.0) | 0.019 |
| Admission heart rate, mean (SD), bpm | 87.7 (26.2) | 88.0 (26.1) | 86.7 (27.0) | 0.711 |
| Admission SBP, mean (SD), mm Hg | 137.6 (31.8) | 138.1 (30.8) | 135.8 (35.4) | 0.599 |
| Admission hemoglobin, mean (SD), g/L | 140.7 (18.6) | 140.3 (18.5) | 142.1 (18.9) | 0.475 |
| Admission creatinine, median (IQR), µmol/L | 97 (81–113) | 97 (79–114) | 97 (86–110) | 0.454 |
| Peak creatinine, median (IQR), µmol/L | 109 (92–137) | 110 (90–140) | 107.5 (96–133) | 0.948 |
| Medications within 24 h of admission, n (%) | ||||
| Aspirin | 314 (99.1) | 244 (98.8) | 70 (100.0) | 1.000 |
| P2Y12 inhibitor | 309 (97.5) | 239 (96.8) | 70 (100.0) | 0.127 |
| Enoxaparin | 105 (33.1) | 75 (30.4) | 30 (42.9) | 0.050 |
| Statin | 306 (96.5) | 238 (96.4) | 68 (97.1) | 0.751 |
| ACEI/ARB | 258 (81.4) | 205 (83.0) | 53 (75.7) | 0.167 |
| β‐blocker | 266 (83.9) | 212 (85.8) | 54 (77.1) | 0.081 |
| MRA | 8 (2.5) | 0 (0.0) | 8 (11.4) | <0.001 |
| Medications at discharge, n (%) | ||||
| Aspirin | 311 (98.1) | 243 (98.4) | 68 (97.1) | 0.617 |
| P2Y12 inhibitor | 302 (95.3) | 234 (94.7) | 68 (97.1) | 0.403 |
| Warfarin | 135 (42.6) | 115 (46.6) | 20 (28.6) | 0.007 |
| Statin | 316 (99.7) | 246 (99.6) | 70 (100.0) | 1.000 |
| ACEI/ARB | 280 (88.3) | 211 (85.4) | 69 (98.6) | 0.002 |
| β‐blocker | 311 (98.1) | 241 (97.6) | 70 (100.0) | 0.345 |
| Optimal medical therapy† | 263 (83.0) | 197 (79.8) | 66 (94.3) | 0.004 |
ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BMI, body mass index; bpm, beats per minute; HF, heart failure; IQR, interquartile range; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MRA, mineralocorticoid receptor antagonist; PCI, percutaneous coronary intervention; SBP, systolic blood pressure; and STEMI, ST‐segment–elevation myocardial infarction.
†
Defined as use of the combination of aspirin plus P2Y12 inhibitor plus ACEI/ARB plus β‐blocker.