Hernandez, A. F. et al. (2024) Effect of empagliflozin on heart failure outcomes after acute myocardial infarction: insights from the EMPACT-MI trial. Circulation, (doi: 10.1161/circulationaha.124.069217) (PMID:38581389) (Early Online Publication)
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Abstract
Background: Empagliflozin reduces the risk of heart failure events in patients with type 2 diabetes at high cardiovascular risk, chronic kidney disease, and in those with prevalent heart failure irrespective of ejection fraction. While EMPACT-MI showed empagliflozin does not reduce the risk of the composite of hospitalization of heart failure and all-cause mortality, the impact of empagliflozin on first and recurrent heart failure events in patients after myocardial infarction is unknown. Methods: EMPACT-MI was a double-blind, randomized, placebo-controlled, event-driven trial that randomized 6522 patients hospitalized for acute myocardial infarction at risk for heart failure based on newly developed left ventricular ejection fraction of <45% and/or signs or symptoms of congestion to receive empagliflozin 10 mg daily or placebo within 14 days of admission. In prespecified secondary analyses, treatment groups were analyzed for heart failure outcomes. Results: Over a median of follow-up of 17.9 months, the risk for first heart failure hospitalization and total heart failure hospitalizations was significantly lower in the empagliflozin compared with the placebo group (118 (3.6%) vs. 153 (4.7%) patients with events, HR 0.77 [95% CI 0.60, 0.98], P=0.031 for first heart failure hospitalization and 148 vs. 207 events, RR 0.67 [95% CI 0.51, 0.89], P=0.006 for total heart failure hospitalizations). Subgroup analysis showed consistency of empagliflozin benefit across clinically relevant patient subgroups for first and total heart failure hospitalizations. Post-discharge need for new use of diuretics, renin-angiotensin modulators, and mineralocorticoid receptor antagonists were less in patients randomized to empagliflozin than placebo (all p<0.05). Conclusions: In patients after acute myocardial infarction with left ventricular dysfunction or congestion, empagliflozin reduced the risk of heart failure.
Item Type: | Articles |
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Additional Information: | Sources of Funding: Boehringer Ingelheim and Eli Lilly and Company. |
Status: | Early Online Publication |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Petrie, Professor Mark |
Authors: | Hernandez, A. F., Udell, J. A., Jones, W. S., Anker, S. D., Petrie, M. C., Harrington, J., Mattheus, M., Seide, S., Zwiener, I., Amir, O., Bahit, M. C., Bauersachs, J., Bayes-Genis, A., Chen, Y., Chopra, V. K., Figtree, G., Ge, J., Goodman, S., Gotcheva, N., Goto, S., Gasior, T., Jamal, W., Januzzi, J. L., Jeong, M. H., Lopatin, Y., Lopes, R. D., Merkely, B., Parikh, P. B., Parkhomenko, A., Ponikowski, P., Rossello, X., Schou, M., Simic, D., Steg, P. G., Szachniewicz, J., van der Meer, P., Vinereanu, D., Zieroth, S., Brueckmann, M., Sumin, M., Bhatt, D. L., and Butler, J. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Circulation |
Publisher: | Lippincott, Williams and Wilkins for the American Heart Association |
ISSN: | 0009-7322 |
ISSN (Online): | 1524-4539 |
Published Online: | 06 April 2024 |
Copyright Holders: | Copyright: © 2024 The Authors |
First Published: | First published in Circulation 2024 |
Publisher Policy: | Reproduced under a Creative Commons licence |
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