Impact of Mineralocorticoid Receptor Antagonists on the Risk of Sudden Cardiac Death Across Cardio-Kidney-Metabolic Diseases: A Meta-Analysis of Randomized Clinical Trials

Aims Sudden cardiac death (SCD) is a prevalent cause of mortality among patients with cardio-kidney-metabolic (CKM) diseases. Mineralocorticoid receptor antagonists (MRAs) reduce the risk of SCD in patients with left ventricular dysfunction, but it is unclear if similar effects are expected across different CKM risk populations irrespective of ejection fraction. Methods and results A random-effects meta-analysis of randomized clinical trials (RCTs) of MRA (vs. placebo) on the occurrence of SCD was performed. The number of reported SCD events were collected from the individual RCTs and the respective odds ratio (OR) and 95% confidence intervals (95% CI) calculated. Data from five major RCTs were collected including over 31 000 patients. Overall, MRAs, compared with placebo, reduced the occurrence of SCD (OR 0.79, 95% CI 0.70–0.89, p < 0.001). No significant heterogeneity was found across trials (I2 = 0%, Q = 0.38, p = 0.98). Conclusion This meta-analysis supports the benefit of MRAs for SCD risk reduction across CKM risk and irrespective of ejection fraction.