Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction ≤30% [Beurteilung der wirkung von eplerenon in der subgruppe der EPHESUS-patienten mit einer linksventrikulären auswurffraktion ≤30% zu studienbe
University of Michigan Medical Center, Alfred Taubman Health Care Center, Ann Arbor, MI, United States; Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Clinical Investigation Center INSERM-CHU, Nancy Hôpital Jeanne d'Arc, Dommartin-les Toul, France; LDS Hospital, Salt Lake City, UT, United States; University Hospital Groningen, Groningen, Netherlands; Institute of Cardiology, Intensive Care Department, Kyiv, Ukraine; Department of Cardiovascular Diseases, Clinical Hospital, Catholic University of Chile, Santiago, Chile; Sunninghill Hospital, Sunninghill, South Africa; Pfizer Inc., New York, NY, United States; University of Michigan Medical Center, Alfred Taubman Health Care Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States
Aims: Because of the prognostic importance of LV dysfunction following an AMI and the increasing use of electrical and/or mechanical interventions in patients with LV systolic dysfunction, this retrospective analysis of EPHESUS patients with LVEF ≤30% at baseline was conducted to determine the value of eplerenone in this setting. Methods and results: In EPHESUS, 6632 patients with LVEF ≤40% and clinical heart failure (HF) post-AMI who were receiving standard therapy were randomized to eplerenone 25 mg/day titrated to 50 mg/day or placebo for a mean follow-up of 16 months. Treatment with eplerenone in the subgroup of patients with LVEF ≤30% (n=2106) resulted in relative risk reductions of 21% versus placebo in both all-cause mortality (p=0.012) and cardiovascular (CV) mortality/CV hospitalization (p=0.001), and 23% for CV mortality (p=0.008). The relative risk of sudden cardiac death (SCD) was reduced 33% (p=0.01) and HF mortality/HP hospitalization was reduced 25% (p=0.005) with eplerenone compared with placebo. Within 30 days of randomization, eplerenone resulted in relative risk reductions of 43% for all-cause mortality (p=0.002), 29% for CV mortality/CV hospitalization (p=0.006), and 58% for SCD (p=0.008). Conclusions: Treatment with eplerenone plus standard therapy in patients with post-AMI HF and LVEF ≤30% provided significant incremental benefits in reducing both early and late mortality and morbidity. © Verlag Perfusion GmbH.