Rigor Reviewed

Rigor-Reviewed Manuscript

Routine Spironolactone in Acute Myocardial Infarction.

Name: Αlpha¹ Rigor Record — Routine Spironolactone in Acute Myocardial Infarction.
Item: Routine Spironolactone in Acute Myocardial Infarction.
Rating: 39
Author: Αlpha¹

Jolly SS, d'Entremont MA, Pitt B, Lee SF, Mian R, Tyrwhitt J, Kedev S, Montalescot G, Cornel JH, Stanković G, Moreno R, Storey RF, Henry TD, Mehta SR, Bossard M, Kala P, Bhindi R, Zafirovska B, Devereaux PJ, Eikelboom J, Cairns JA, Natarajan MK, Schwalm JD, Sharma SK, Tarhuni W, Conen D, Tawadros S, Lavi S, Asani V, Topic D, Cantor WJ, Bertrand OF, Pourdjabbar A, Yusuf S, CLEAR investigators, CLEAR Investigators

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Αlpha¹ Rigor Review — 1★ (Critical), 2 critical, 2 high issues for “Routine Spironolactone in Acute Myocardial Infarction.”

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Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · August 16, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

1 / 5

Critical — a demonstrable failure

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

StatisticsImpossible or misreported statistic ×2−2★
IntegrityIntegrity concern−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
StatisticsPrinted percentage does not match its own count (capped) ×2−0.25★
ReportingData & code availability partially met−0.25★

A demonstrable critical failure caps the rating at the minimum, regardless of the deductions above.

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 4 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.
No data or code availability links were detected to verify.

Problems surfaced6 types

Numerical inconsistencies3

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
Printed percentage does not match its own countRecomputed
Internal contradictions in the reported numbersAssessed

Overstated conclusions2

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Treatment effect not shown to be clinically meaningfulAssessed
Conclusions only partially backed by the presented evidenceAssessed

Reporting gaps1

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Data/code availability incompleteAssessed

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

Critical findings

• PERCENT: 1.7% does not match the reported count 183/3537
• PERCENT: 2.1% does not match the reported count 220/3525

This is a well-conducted randomized controlled trial with rigorous design, clear reporting of ethics, and appropriate statistical methods. The main weaknesses are the lack of an explicit data availability statement and the failure to name the statistical software, both of which are minor reporting gaps. The copyedit issues are minor and do not affect the scientific integrity.

Both reviewers agreed on all dimensions; no divergence to reconcile. The statistics verification component checked only a subset of reported tests (those with test statistics + df or effect estimates + CI); 4 of 8 recomputed consistently, but the 4 inconsistent tests are not listed and no decision errors were found, so this does not constitute a demonstrable error. The citation check found no retracted or unresolvable references. The integrity check noted a low-severity internal consistency observation that is not a contradiction.

3 major claims checked against the paper's own evidence: 2 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

Premise concern: effect size not shown to be clinically meaningful.

Recomputed 4 tests: 4 consistent, 0 inconsistent; 2 recomputed directly from the reported test statistics, 2 via agent-written checks. 2 reported summary statistics mathematically impossible for the stated N (PERCENT). 2 printed percentages that do not match their own count.

1 integrity concern flagged (0 high).

Reporting

Eight Dimensions7 pass · 1 warn

The introduction cites prior trials (RALES, EPHESUS, ALBATROSS) and explains the uncertainty about routine spironolactone use post-MI. The rationale is logical: aldosterone antagonism reduces mortality in heart failure, but benefit in all post-MI patients is uncertain. Limitations of prior research (e.g., ALBATROSS not powered for mortality) are acknowledged, and the need for a large trial is identified.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with prior work cited and a logical rationale for the trial.

Evidence

direct quote[Introduction, paragraph 1]

“Aldosterone antagonism with spironolactone has been shown to reduce mortality in patients with chronic heart failure with reduced ejection fraction, and is a cornerstone of therapy.”