Safety and efficacy of early use of mineralocorticoid receptor antagonists in cardiogenic shock: a propensity score-matched analysis
- 25.08.2025
- Original Paper
Erschienen in:
- Verfasst von
- Miloud Cherbi
- François Roubille
- Paul Gautier
- Etienne Puymirat
- Meyer Elbaz
- Laurent Bonello
- Nicolas Lamblin
- Eric Bonnefoy
- Clément Delmas
- Erschienen in
- Clinical Research in Cardiology | Ausgabe 10/2025
Abstract
Background
Despite its high incidence and mortality, the level of evidence for cardiogenic shock (CS) treatments remains very low. This study aims to evaluate the influence of early treatment with mineralocorticoid receptor antagonist (MRA) in CS.
Methods
FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. The association between early MRA use and 30-day all-cause mortality was assessed in a 1:3 propensity-matched cohort. Early MRA use was defined as documented use within 24 h of admission.
Results
Among the 693 CS patients included, MRAs were used in 91 (13.1%). Patients treated with MRA presented with a more frequent history of cardiac disease (78.0% vs. 56.0%, p < 0.01) and had lower LVEF (20.0% vs. 25.0%, p = 0.01). After matching, 91 patients treated with MRA were compared to 273 patients who did not receive MRA. MRA use was associated with a significant reduction in 30-day mortality, with a matched HR of 0.49 (0.27–0.91), p = 0.02. In subgroup analysis, the benefit of MRA appeared more pronounced in patients with severely reduced LVEF (≤ 20%) or acute myocardial infarction. There were no increased risks of hyperkalaemia or worsening renal function after 24 h of management, albeit with a risk of hypotension.
Conclusion
In this prospective, multicentre, nationwide, propensity score-matched study of patients with a broad spectrum of CS aetiologies, early MRA use was associated with a significant reduction in 30-day all-cause mortality. Further randomized trials are needed to confirm its benefit and clarify its role in therapeutic management.
Graphical Abstract
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- Titel
- Safety and efficacy of early use of mineralocorticoid receptor antagonists in cardiogenic shock: a propensity score-matched analysis
- Verfasst von
-
Miloud Cherbi
François Roubille
Paul Gautier
Etienne Puymirat
Meyer Elbaz
Laurent Bonello
Nicolas Lamblin
Eric Bonnefoy
Clément Delmas
- Publikationsdatum
- 25.08.2025
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
Clinical Research in Cardiology / Ausgabe 10/2025
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692 - DOI
- https://doi.org/10.1007/s00392-025-02741-1
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