ALBATROSS

The blockade of the renin-angiotensin-aldosterone (RAA) pathway by angiotensin conversion enzyme inhibitors (ACEI) is one corner stone in the management of heart failure as well as the management of ischemic heart disease, especially after acute myocardial infarctionHigh plasma aldosterone levels have been associated with both direct and indirect toxic effects on myocardium. ACEIs are associated with partial and temporary reduction of plasma aldosterone levels. The RALES randomized controlled trial has shown a reduction of mortality associated with the use of the selective aldosterone receptor blocker spironolactone, on top of standard therapy including ACEIs in the setting of NYHA 3-4 chronic heart failure. The EPHESUS randomized controlled trial has shown a reduction of mortality associated with the use of another selective aldosterone receptor blocker Eplerenone, initiated 3 to 14 days after acute myocardial infarction complicated by clinical heart failure and left ventricular ejection fraction <40&. Both previous studies have also reported a rapid reduction of global and arrhythmia-related mortality, within 30 days after the initiation of the medication.Such benefit has been reported after delayed initiation of aldosterone blocked, while aldosterone is at its highest level at presentation after acute myocardial infarction, with a rapid decrease within days after admission. Furthermore high aldosterone levels on admission are associated with adverse outcome independent of heart failure.
The hypothesis of the ALBATROSS trial : an early blockade of aldosterone receptors initiated at the first medical contact after acute myocardial infarction may reduce major cardiovascular events within 6 months after the occurrence of the myocardial infarction.

• Early Aldosterone Blockade in Acute Myocardial Infarction : The ALBATROSS Randomized Clinical Trial
  Farzin Beygui, Guillaume Cayla, Vincent Roule, François Roubille, Nicolas Delarche, Johanne Silvain, Eric Van Belle, Loic Belle, Michel Galinier, Pascal Motreff, Luc Cornillet, Jean-Philippe Collet, Alain Furber, Patrick Goldstein, Patrick Ecollan, Damien Legallois, Alain Lebon, Hélène Rousseau, Jacques Machecourt, Faiez Zannad, Eric Vicaut, Gilles Montalescot, ALBATROSS Investigators
  Publié dans Journal of the American College of Cardiology
• Rationale for an early aldosterone blockade in acute myocardial infarction and design of the ALBATROSS trial
  Farzin Beygui, Eric Vicaut, Patrick Ecollan, Jacques Machecourt, Eric Van Belle, Faiez Zannad, Gilles Montalescot
  Publié dans American Heart Journal

• ESC2017 - Présentation 'Albatross & Reminder trials update'
  powerpoint pdf