Cardiorenal outcomes with finerenone in patients post-acute myocardial infarction: Insights from a global federated network

Abstract Background Finerenone, a non-steroidal mineralocorticoid receptor antagonist (nsMRA), improves cardiorenal outcomes in chronic kidney disease, type 2 diabetes, and heart failure. However, its clinical efficacy and safety when initiated early after acute myocardial infarction (AMI) remain unknown. Methods This retrospective cohort study utilized the TriNetX global federated network to identify adult patients with AMI who initiated finerenone within 6 months of the index event. These were compared to a propensity score-matched control group of AMI survivors who did not receive finerenone. Results After 1:1 propensity score matching, 1,012 patients were included (506 per group; mean age 69 years). The cohort represented a high-risk phenotype with a high prevalence of type 2 diabetes (∼84%) and CKD (∼80%). Over a 2-year follow-up, finerenone treatment was associated with a lower risk of the composite endpoint of mortality and heart failure (HR 0.644; 95% CI 0.495–0.837; P < 0.001). Notably, finerenone was also associated with a lower risk of progression to ESRD or CKD stage 5 (HR 0.573; 95% CI 0.387–0.851; P = 0.005) and all-cause hospitalization (HR 0.602; 95% CI 0.482–0.751; P < 0.001). There was no significant difference in the risk of adverse events, including hyperkalemia, hyponatremia, and syncope or hypotension between groups. Conclusion In this real-world study of high-risk post-AMI patients, early initiation of finerenone was associated with lower risks of composite cardiovascular events, all-cause mortality, and renal disease progression, without a significant increase in adverse events. These findings warrant validation in prospective randomized controlled trials.