Why are Mineralocorticoid Receptor Antagonists the Cinderella in Evidence-based Treatment of Myocardial Infarction Complicated With Heart Failure?

Lessons From PARADISE-MI

Bertram Pitt; João Pedro Ferreira; Faiez Zannad


Eur Heart J. 2022;43(14):1428-1431. 

In This Article

Abstract and Introduction


Graphical Abstract


Over the past few decades, several therapeutical advances have improved the outcomes of patients with a reduced left ventricular ejection fraction (LVEF) and evidence of heart failure (HF) in the early post-myocardial infarction (MI) period.[1] Landmark trials have established beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor-blocking agents (ARBs), and mineralocorticoid receptor antagonists (MRAs) as the 'backbone' neurohormonal modulating therapy for patients who had an MI complicated by left ventricular systolic dysfunction (LVSD) and HF.[2–5] Beyond these neurohormonal antagonists, lipid-lowering drugs, new anti-platelet and anti-thrombotic agents, and advanced reperfusion and revascularization techniques have contributed to an important reduction of recurrent cardiovascular events and mortality in this population.[1]