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Spironolactone, a mineralocorticoid receptor antagonist, is established in the treatment of heart failure following myocardial infarction (MI). However, its routine use post-MI remains uncertain.
This multicenter trial (CLEAR) randomized 7062 patients with MI 3537 receiving spironolactone (25 mg daily) and 3525 receiving placebo—evaluating two primary outcomes over a median follow-up of three years:
- Death from cardiovascular causes or new/worsening heart failure
- First occurrence of MI, stroke, new/worsening heart failure, or cardiovascular death