Rol del bloqueo aldosterónico en la insuficiencia cardíaca post infarto agudo de miocardio

cardiac remodeling remains the leading cause of heart failure (hf) progression and death after an acute myocardial infarction (ami). therapeutic strategies directed towards physiopathologic mechanisms of healing and remodeling seems to be useful means to prevent progressive functional impairment, arrhythmias and congestive heart failure. in two consecutive meetings, 50 experts critically reviewed the available evidence. the present document reflects the consensus of the subject: "role of aldosterone blockade in heart failure post acute myocardial infarction". clinical interest in blocking aldosterone in patients treated with an angiotensin-converting enzyme (ace) inhibitors or angiotensin receptor blockers (arbs) was stimulated by the randomized aldactone evaluation study (rales), which demonstrated that the mineralocorticoid (mc) antagonist spironolactone reduced the risk of all-cause mortality as well as hospitalizations for hf in patients with severe nyha class iii-iv hf and a reduced left ventricular ejection fraction (lvef). shortly after, the post acute myocardial infarction heart failure efficacy and survival study (ephesus) showed a benefit of the second-generation mr antagonist eplerenone on all-cause mortality as well as hospitalizations for hf early post-ami. concluding that the current indications for aldosterone blockers are therefore clear for patients with moderate to severe symptoms (nyha functional class iii-iv), who have a decrease lvef and signs and symptoms of heart failure despite optimal background treatment. the guidelines also support the use of these drugs in patients with left ventricular dysfunction after ami