Eplerenone lowers mortality following Acute Myocardial Infarction

by Bruce Sylvester – Emerging uses of FDA approved drugs – Eplerenone,  a drug used to reduce the risk of death in patients with heart failure, shows significant mortality-related efficacy when administered to patients following an acute (ST elevated) myocardial infarction.

The finding comes from a newly published meta-analysis of relevant studies.The finding appeared in all study sub-groups, but was “particularly obvious in patients undergoing reperfusion within six hours of symptom onset,” the researchers said.

The study appeared on April 30, 2014 in the European Heart Journal.

The principal investigator Gilles Montalescot , MD, Ph.D, of the Institut de Cardiologie, Pitié-Salpêtrière University Hospital in Paris, said the study was, “a valuable venture both because of the potentially beneficial effects and a proof of safety in the acute phase of MI”.

The researchers in the placebo-controlled trial enrolled 1012 acute STEMI patients with no history of heart failure. They were randomized to eplerenone (25/50 mg per day) or placebo, begun within 24 hours of symptom onset and adjunctive to standard medical care.

The primary endpoint of the study was a composite of cardiovascular mortality, re-hospitalization or extended initial hospital stay as a result of diagnosed heart failure, sustained ventricular tachycardia or fibrillation, and laboratory tested measures of natriuretic peptides which serve as signs of heart failure (BNP or Nt-proBNP)

After a mean follow-up of 10.5 months, the primary endpoint appeared in 93 patients in the eplerenone group (18.4%) and in 150 patients in the placebo group (29.6%), with a statistically significant difference (P<0.0001).

Notably, the primary endpoint divergence was accounted for by changes in levels of BNP/NT or proBNP, with statistically significant overall lower levels in the eplerenone group.

The authors described eplerenone use in the study as “safe” and “generally well tolerated.”

Dr. Montalescot added, “This study suggests that eplerenone can be used early in the course of MI without safety issues. The long term benefit on remodelling and secondary heart failure is possible but will deserve further studies.”