Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction <= 30%
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Date
2006
Journal Title
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Publisher
ELSEVIER SCIENCE BV
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. (c) 2005 European Society of Cardiology Published by Elsevier B.V. All rights reserved.
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. (c) 2005 European Society of Cardiology Published by Elsevier B.V. All rights reserved.
Description
Keywords
aldosterone, heart failure, left ventricular systolic dysfunction, eplerenone, EPHESUS, ACUTE MYOCARDIAL-INFARCTION, IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR, SELECTIVE ALDOSTERONE BLOCKER, HEART-RATE-VARIABILITY, OXIDATIVE STRESS, SPIRONOLACTONE, FAILURE, DYSFUNCTION, PREVENTS