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Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction ≤30%
Author(s) -
Pitt Bertram,
Gheorghiade Mihai,
Zannad Faiez,
Anderson Jeffrey L.,
Veldhuisen Dirk J.,
Parkhomenko Alexander,
Corbalan Ramon,
Klug Eric Q.,
Mukherjee Robin,
Solomon Henry
Publication year - 2006
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2005.11.008
Subject(s) - eplerenone , medicine , ejection fraction , heart failure , placebo , cardiology , spironolactone , randomization , subgroup analysis , relative risk , randomized controlled trial , meta analysis , confidence interval , alternative medicine , pathology
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.