***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract Objective : Heart failure is frequently a serious complication of acute myocardial infa rct ion ( AMI ) .  ACE inhibitors , Angiotensin II receptor blockers , β-blockers and aldosterone receptor blockers have been shown to improve outcomes in this setting . This study aim ed to determine the effect of spironolactone on the frequency of clinical heart failure , mortality , rehospitalization and left ventricular functions determined by echocardiography . Material and methods : A total of 82 patients with STEMI hospitalized within 6–12 h of debut of symptoms were included in the study . The patients were r and omly assigned into spironolactone ( group A ) or placebo ( group B ) groups after informed consent had been obtained . Results : All patients were followed for 6 months . There were no statistically significant differences between the two groups when demographic criteria were compared . The incidence of post-MI angina pectoris , rhythm and conduction disturbance during hospitalization was significantly higher in Group B than in Group A. Although not statistically significant , the incidence of clinical heart failure was slightly lower in Group A than in Group B ( 5 % versus 11 % ) . Left ventricular end-diastolic volumes were slightly lower in Group A than in Group B , although statistically this was not significant . Conclusions : In concordance with these findings , the ejection fraction was slightly higher in Group A than in Group B , although this was not statistically significant ( 47 % versus 44 % ) . This trend continued during a 6-month follow-up after r and omization . Our findings suggest that early administration of aldosterone blockers provides additional benefits after AMI , reducing the incidence of post-MI angina pectoris and rhythm and conduction disturbances Abstract Background . Aldosterone exerts pro-fibrotic effects , acting via mineralo-corticoid reeptors in cardiovascular tissues . Aldosterone antagonism in combination with ACE inhibition may better protect against untoward effects of aldosterone than ACE inhibition alone . Methods . In a double blind , r and omised study the tolerability and efficacy of canreonate ( 25 mg/day ) plus captopril versus captopril alone were evaluated in 187 patients with an acute anterior myocardial infa rct ion ( MI ) and a serum creatinine concentration < 2.0 mg/dL and a serum K concentration < 5.0 mmol/L. Ninety-four patients received captopril and 25 mg canreonate ( group A ) . Group B ( 93 patients ) received captopril and placebo . At baseline and at 10 and 90 days after admission Doppler echocardiography was performed . Results . Clinical and demographic aspects were similar in both groups . Also , baseline cardiac enzyme levels , left ventricular ( LV ) function and incidence of surgical interventions and angioplasty were comparable . Overall , creatinine , blood urea and serum K did not show significant differences between groups . However , in 9 patients in group A increases in serum K > 5.5 mmol/dL and creatinine > 2.0 mg/L were observed after 10 days of treatment . At 90 days , the mitral E/A ratio was higher ( p = 0.001 ) and LV end systolic volume smaller ( p = 0.021 ) in patients treated with canreonate than in those receiving placebo . No further side effects were observed during the study period . Conclusions . Our data suggest that the combination of captopril plus canreonate is well tolerated following an acute myocardial infa rct ion and has a beneficial effect on diastolic and systolic LV parameters and may decrease post-MI remodelling AIMS Direct renin inhibitors provide an alternative approach to inhibiting the renin-angiotensin-aldosterone system ( RAAS ) at the most proximal , specific , and rate-limiting step . We tested the hypothesis that direct renin inhibition would attenuate left ventricular remodelling in patients following acute myocardial infa rct ion receiving stable , individually optimized therapy , including another inhibitor of the RAAS . METHODS AND RESULTS We r and omly assigned 820 patients between ∼2 and 8 weeks following acute myocardial infa rct ion , with the left ventricular ejection fraction ( LVEF ) ≤45 % , and regional wall motion abnormalities ( ≥20 % akinetic area ) , to  receive aliskiren ( n = 423 ) , titrated to 300 mg , or matched placebo ( n = 397 ) , added to the st and ard therapy . All patients were required to be on a stable dose of an ACE-inhibitor or ARB , and beta-blocker unless contraindicated or not tolerated . Echocardiograms were obtained at baseline , and following 26 - 36 weeks of treatment . The primary endpoint was change in left ventricular end-systolic volume from baseline to 36 weeks , and was evaluable in 329 patients in the placebo group and 343 patients in the aliskiren group . We observed no difference in the primary endpoint of end-systolic volume change between patients r and omized to aliskiren ( -4.4 ± 16.8 mL ) or placebo ( -3.5 ± 16.3 mL ) , or in secondary measures of end-diastolic volume , or LVEF . We also observed no differences in a composite endpoint of cardiovascular death , hospitalization for heart failure , or reduction in LVEF > 6 points . There were more investigator reported adverse events in the aliskiren group , including hypotension , increases in creatinine and hyperkalaemia . CONCLUSION Adding the direct renin inhibitor aliskiren to the st and ard therapy , including an inhibitor of the RAAS , in high-risk post-MI patients did not result in further attenuation of left ventricular remodelling , and was associated with more adverse effects . These findings do not suggest that dual RAAS blockade with aliskiren would provide additional benefit in these high-risk post-MI patients Background —Mineralocorticoid receptor antagonists reduce morbidity and mortality in patients with heart failure but can cause hyperkalemia , which contributes to reduced use of these drugs . Hypokalemia also leads to worse outcomes in patients with heart failure and may be attenuated by mineralocorticoid receptor antagonists . Methods and Results —We assessed incidence and predictors of hyperkalemia ( potassium ≥5.5 mmol/L ) and hypokalemia ( potassium < 3.5 mmol/L ) and the relationship to outcomes in 1663 patients with class III or IV heart failure and left ventricular ejection fraction < 35 % r and omized to treatment with spironolactone 25 mg or placebo in the R and omized Aldactone Evaluation Study ( RALES ) trial .  All-cause mortality rates and the influence of potassium levels on the effectiveness of spironolactone were assessed in a l and mark analysis and in relation to time-varying potassium levels . After 1 month , mean potassium levels increased in the spironolactone group but not in the placebo group ( 4.54±0.49 versus 4.28±0.50 mmol/L ; P<0.001 ) and remained elevated during the trial . Although the extremes of hypokalemia and hyperkalemia at 4 weeks were associated with increased risk of mortality in both treatment arms , participants in the spironolactone arm had lower mortality rates at all potassium levels throughout the duration of the trial . The treatment benefit of spironolactone was maintained at least until potassium exceeded 5.5 mmol/L. Conclusions —With appropriate surveillance of potassium and creatinine , the use of spironolactone was associated with less hypokalemia and improved survival in patients with severe heart failure even in the setting of moderate hyperkalemia Background — Aldosterone , the final mediator of the renin-angiotensin-aldosterone pathway , is at its highest plasma levels at presentation for ST-elevation myocardial infa rct ion ( STEMI ) . Whether aldosterone level at presentation for STEMI is associated with adverse outcome remains unknown . Methods and Results —  Plasma aldosterone levels were measured at presentation in consecutive patients referred for primary percutaneous coronary intervention for STEMI .  We assessed the association between aldosterone levels and in-hospital events and mortality during a 6-month follow-up . Of 356 STEMI patients , 23 and 36 died during the hospital stay and 6-month follow-up period , respectively . Nine other patients survived in-hospital cardiac arrest . High aldosterone levels were associated with an almost stepwise increase in rates of in-hospital death ( P=0.01 ) , cardiovascular death ( P=0.03 ) , heart failure ( P=0.005 ) , ventricular fibrillation ( P=0.02 ) , and resuscitated cardiac arrest ( P=0.01 ) . After adjustment for age , Killip class , and reperfusion status , compared with patients in the first aldosterone quartile group , those in the highest quartile were at higher risk of death ( hazard ratio 3.28 , 95 % CI 1.09 to 9.89 , P=0.035 ) and death or resuscitated cardiac arrest ( hazard ratio 3.74 , 95 % CI 1.40 to 9.98 , P=0.008 ) during the follow-up . Conclusions — Plasma aldosterone levels on admission among patients referred for primary percutaneous coronary intervention for STEMI are associated with early and late adverse clinical outcomes , including mortality . The association between high aldosterone levels and late mortality is independent of age , heart failure , and reperfusion status . Such results underline the pivotal role of aldosterone and justify a r and omized trial to assess the early administration of aldosterone antagonists in the setting of STEMI AIMS We aim ed to assess the impact of eplerenone on cardiovascular ( CV ) outcomes in STEMI without known heart failure , when initiated within 24 h of symptom onset . METHODS AND RESULTS In this r and omized , placebo-controlled , double-blind trial , we assigned 1012 patients with acute STEMI and without a history of heart failure to receive either eplerenone ( 25 - 50 mg once daily ) or placebo in addition to st and ard therapy . The primary endpoint was the composite of CV mortality , re-hospitalization , or , extended initial hospital stay , due to diagnosis of HF , sustained ventricular tachycardia or fibrillation , ejection fraction ≤40 % , or elevated BNP/NT-proBNP  at 1 month or more after r and omization .  BNP elevation was defined as BNP levels or values above 200 pg/mL or NT-proBNP values above 450 pg/mL ( in patients aged below 50 ) ; above 900 pg/mL ( age 50 - 75 years ) or above 1800 pg/mL ( patients older than 75 ) . After a mean follow-up of 10.5 months , the primary endpoint occurred in 92 patients ( 18.2 % ) in the eplerenone group and in 149 patients ( 29.4 % ) in the placebo group [ adjusted hazard ratio ( HR ) , 0.58 ; 95 % confidence interval ( CI ) , 0.45 - 0.76 ; P < 0.0001 ] . The primary endpoint was driven by a high BNP/NT-proBNP level ( adjusted HR , 0.60 ; 95 % CI , 0.45 - 0.79 ; P < 0.0003 ) . Adverse event rates were similar in both groups . Serum potassium levels exceeded 5.5 mmol/L in 5.6 vs. 3.2 % ( P = 0.09 ) and were below 3.5 mmol/L in 1.4 vs. 5.6 % of patients ( P = 0.0002 ) , in the eplerenone and placebo groups , respectively . CONCLUSION The addition of eplerenone during the acute phase of STEMI was safe and well tolerated . It reduced the primary endpoint over a mean 13 months follow-up mostly because of significantly lower BNP/NT-proBNP levels . Additional studies are needed to clarify the role of early use of MRAs in STEMI patients without heart failure . CLINICAL TRIAL REGISTRATION NCT01176968 BACKGROUND Mineralocorticoid receptor antagonists ( MRA ) improve outcome in the setting of post-myocardial infa rct ion ( MI ) heart failure ( HF ) . OBJECTIVES The study sought to assess the benefit of an early MRA regimen in acute MI irrespective of the presence of HF or left ventricular ( LV ) dysfunction . METHODS We r and omized 1,603 patients to receive an MRA regimen  with a single intravenous bolus of potassium canrenoate ( 200 mg ) followed by oral spironolactone ( 25 mg once daily ) for 6 months in addition to st and ard therapy or st and ard therapy alone . The primary outcome of the study was the composite of death , resuscitated cardiac arrest , significant ventricular arrhythmia , indication for implantable defibrillator , or new or worsening HF at 6-month follow-up . Key secondary /safety outcomes included death and other individual components of the primary outcome and rates of hyperkalemia at 6 months . RESULTS The primary outcome occurred in 95 ( 11.8 % ) and 98 ( 12.2 % ) patients in the treatment and control groups , respectively ( hazard ratio [ HR 
    Output:
    
Conclusions Administration of MRA may reduce mortality after acute MI .
However , this is largely based on post‐MI patients with heart failure .