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Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction <or=30%.

Author(s): Pitt B, Gheorghiade M, Zannad F, Anderson JL, van Veldhuisen DJ, Parkhomenko A, Corbalan R, Klug EQ, Mukherjee R, Solomon H, On behalf of the EPHESUS Investigators

Affiliation(s): University of Michigan Medical Center, Alfred Taubman Health Care Center, 1500 East Medical Center Drive, Ann Arbor, 48109, USA. bpitt@med.umich.edu

Publication date & source: 2006-05, Eur J Heart Fail., 8(3):295-301. Epub 2006 Feb 28.

Publication type: Randomized Controlled Trial

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 <or=30% at baseline was conducted to determine the value of eplerenone in this setting. METHODS AND RESULTS: In EPHESUS, 6,632 patients with LVEF <or=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 <or=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 <or=30% provided significant incremental benefits in reducing both early and late mortality and morbidity.

Page last updated: 2006-11-05

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