Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction <or=30%.
OBJECTIVE
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 <or=30% at baseline was conducted to determine the value of eplerenone in this setting.


RESULTS
In EPHESUS, 6,632 patients with LVEF <or=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 <or=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/HF 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 <or=30% provided significant incremental benefits in reducing both early and late mortality and morbidity.
Pitt
Bertram
B
University of Michigan Medical Center, Alfred Taubman Health Care Center, 1500 East Medical Center Drive, Ann Arbor, 48109, USA. bpitt@med.umich.edu
Gheorghiade
Mihai
M
Zannad
Faiez
F
Anderson
Jeffrey L
JL
van Veldhuisen
Dirk J
DJ
Parkhomenko
Alexander
A
Corbalan
Ramon
R
Klug
Eric Q
EQ
Mukherjee
Robin
R
Solomon
Henry
H
D000328:Adult; D000368:Aged; D000077545:Eplerenone; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013318:Stroke Volume / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects*
D013148:Spironolactone; D000077545:Eplerenone