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. © 2005 European Society of Cardiology.