Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction ≤30%

Abstract: 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/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 ≤30% provided significant incremental benefits in reducing both early and late mortality and morbidity. [Copyright &y& Elsevier]