Comparison of steroidal and nonsteroidal mineralocorticoid receptor antagonists on the incidence of new-onset cardiac arrhythmias following myocardial infarction: A retrospective cohort study.

OBJECTIVE: Aim: The purpose of this study was to compare the incidence of new-onset cardiac arrhythmias in post-myocardial infarction (MI) patients treated with nonsteroidal versus steroidal MRAs. PATIENTS AND METHODS: Materials and Methods: A retrospective cohort study was conducted using the TriNetX database, including MI patients without a prior history of cardiac arrhythmias who received either nonsteroidal or steroidal MRAs. Propensity score matching was performed across 28 baseline variables, including demographics, cardiovascular risk factors, medication use, and laboratory values. The primary outcome was the incidence of new-onset cardiac arrhythmia, while secondary outcomes included the individual components of the primary outcome (atrial and ventricular arrhythmias) as well as cardiac arrest events. RESULTS: Results: After matching, 861 patients were included in each cohort (nonsteroidal and steroidal mineralocorticoid). New-onset cardiac arrhythmia occurred in 62 patients (9.1%) in the nonsteroidal group and 97 patients (15.6%) in the steroidal group. However, the risk of developing new-onset cardiac arrhythmia did not differ significantly between the two cohorts (HR: 0.856; 95% CI: 0.614-1.193; P=0.284). Secondary outcomes also showed no significant differences: atrial arrhythmia (HR: 0.752; 95% CI: 0.520-1.089; P=0.125), ventricular arrhythmia (HR: 1.016; 95% CI: 0.558-1.850; P=0.647), and cardiac arrest (HR: 0.851; 95% CI: 0.465-1.558; P=0.081). CONCLUSION: Conclusions: Our findings showed no difference in the incidence of new-onset cardiac arrhythmias or in secondary outcomes between patients treated with nonsteroidal versus steroidal MRAs. Prospective, standardized studies are needed to validate these results.