The routine use of spironolactone after a heart attack did not reduce primary outcomes in the CLEAR SYNERGY trial, but it may reduce heart failure. The trial had high drug discontinuation rates, impacting results. The study also investigated colchicine effects, which showed no benefit. Eplerenone was beneficial for heart failure after a heart attack in a previous trial. The spironolactone arm of CLEAR SYNERGY had fewer cardiovascular events but more hyperkalemia and gynecomastia. An on-treatment analysis suggested benefits in preventing heart failure, especially in patients with ST elevation myocardial infarction. Further research is needed to identify patients who may benefit most from spironolactone.
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Spironolactone Shows Mixed Results in Acute MI
