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Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial

BACKGROUND: Trials using mineralocorticoid receptor antagonists (MRAs) in myocardial infraction (MI) without heart failure (HF) or systolic impairment have been underpowered to assess morbidity‐mortality benefit. In EPHESUS 6632 patients were included, of whom 11% had an ejection fraction (EF) of 40...

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Autores principales: Ferreira, João Pedro, Rossello, Xavier, Pitt, Bertram, Rossignol, Patrick, Zannad, Faiez
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Periodicals, Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837025/
https://www.ncbi.nlm.nih.gov/pubmed/31482613
http://dx.doi.org/10.1002/clc.23261
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author Ferreira, João Pedro
Rossello, Xavier
Pitt, Bertram
Rossignol, Patrick
Zannad, Faiez
author_facet Ferreira, João Pedro
Rossello, Xavier
Pitt, Bertram
Rossignol, Patrick
Zannad, Faiez
author_sort Ferreira, João Pedro
collection PubMed
description BACKGROUND: Trials using mineralocorticoid receptor antagonists (MRAs) in myocardial infraction (MI) without heart failure (HF) or systolic impairment have been underpowered to assess morbidity‐mortality benefit. In EPHESUS 6632 patients were included, of whom 11% had an ejection fraction (EF) of 40% and HF or diabetes. We aim to assess the potential benefit of MRAs in MI with EF of 40%. METHODS: Cox models with interaction term for EF. The primary outcome was a composite of cardiovascular death or hospitalization for cardiovascular reasons. HYPOTHESIS: Patients with an EF of 40% benefit similarly from MRA therapy to those with an EF <40%. RESULTS: In EPHESUS, 753 patients had an EF = 40% and 5864 an EF < 40%. Patients with an EF = 40% were younger (63 vs 64 years), had lower heart rate (73 vs 75 bpm), less atrial fibrillation (10% vs 14%), previous MI (21% vs 28%), HF hospitalization (5% vs 8%), and had more often reperfusion therapy and/or revascularization (55% vs 44%). The mean EF was 40.0 ± 0.3% in those with EF = 40% vs 32.2 ± 5.9% in those with EF < 40%. The primary outcome occurred in 13.3% (10 events per 100 py) of the patients with EF = 40% vs 22.9% (19 events per 100 py) in those with EF < 40%; adjusted HR for EF = 40% vs <40% = 0.65 (0.53‐0.81). Eplerenone reduced the event‐rate homogenously regardless of EF (interaction(p) EF = 40% vs EF < 40% = 0.21). Similar findings were observed for cardiovascular and all‐cause death. CONCLUSION: Eplerenone reduces hospitalizations and mortality in patients with MI and EF = 40% similarly to patients with EF < 40%. These findings suggest that MI patients with EF in the “mid‐range zone” may also benefit from MRA therapy which might help clinicians in their treatment decisions.
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spelling pubmed-68370252019-11-12 Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial Ferreira, João Pedro Rossello, Xavier Pitt, Bertram Rossignol, Patrick Zannad, Faiez Clin Cardiol Clinical Investigations BACKGROUND: Trials using mineralocorticoid receptor antagonists (MRAs) in myocardial infraction (MI) without heart failure (HF) or systolic impairment have been underpowered to assess morbidity‐mortality benefit. In EPHESUS 6632 patients were included, of whom 11% had an ejection fraction (EF) of 40% and HF or diabetes. We aim to assess the potential benefit of MRAs in MI with EF of 40%. METHODS: Cox models with interaction term for EF. The primary outcome was a composite of cardiovascular death or hospitalization for cardiovascular reasons. HYPOTHESIS: Patients with an EF of 40% benefit similarly from MRA therapy to those with an EF <40%. RESULTS: In EPHESUS, 753 patients had an EF = 40% and 5864 an EF < 40%. Patients with an EF = 40% were younger (63 vs 64 years), had lower heart rate (73 vs 75 bpm), less atrial fibrillation (10% vs 14%), previous MI (21% vs 28%), HF hospitalization (5% vs 8%), and had more often reperfusion therapy and/or revascularization (55% vs 44%). The mean EF was 40.0 ± 0.3% in those with EF = 40% vs 32.2 ± 5.9% in those with EF < 40%. The primary outcome occurred in 13.3% (10 events per 100 py) of the patients with EF = 40% vs 22.9% (19 events per 100 py) in those with EF < 40%; adjusted HR for EF = 40% vs <40% = 0.65 (0.53‐0.81). Eplerenone reduced the event‐rate homogenously regardless of EF (interaction(p) EF = 40% vs EF < 40% = 0.21). Similar findings were observed for cardiovascular and all‐cause death. CONCLUSION: Eplerenone reduces hospitalizations and mortality in patients with MI and EF = 40% similarly to patients with EF < 40%. These findings suggest that MI patients with EF in the “mid‐range zone” may also benefit from MRA therapy which might help clinicians in their treatment decisions. Wiley Periodicals, Inc. 2019-09-03 /pmc/articles/PMC6837025/ /pubmed/31482613 http://dx.doi.org/10.1002/clc.23261 Text en © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Investigations
Ferreira, João Pedro
Rossello, Xavier
Pitt, Bertram
Rossignol, Patrick
Zannad, Faiez
Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial
title Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial
title_full Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial
title_fullStr Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial
title_full_unstemmed Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial
title_short Eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: An analysis from the EPHESUS trial
title_sort eplerenone in patients with myocardial infarction and “mid‐range” ejection fraction: an analysis from the ephesus trial
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837025/
https://www.ncbi.nlm.nih.gov/pubmed/31482613
http://dx.doi.org/10.1002/clc.23261
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