Udell, J. A. et al. (2024) Left ventricular function, congestion, and effect of empagliflozin on heart failure risk after myocardial infarction. Journal of the American College of Cardiology, (doi: 10.1016/j.jacc.2024.03.405) (PMID:38588929)
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Abstract
Background Empagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI). Objective To evaluate the association between left ventricular ejection fraction (LVEF), congestion, or both on outcomes and the impact of empagliflozin in reducing HF risk post-MI. Methods In the EMPACT-MI trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF<45%, congestion, or both to empagliflozin 10 mg daily or placebo and followed for a median of 17.9 months. Results Among 6522 patients, the mean baseline LVEF was 41%+9%; 2648 patients (40.6%) presented with LVEF<45% alone, 1483 (22.7%) presented with congestion alone, and 2181 (33.4%) presented with both. Among patients in the placebo arm, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause death or HF hospitalization (hazard ratio [HR] 1.49; 95%CI, 1.31-1.69; P<0.0001), first HF hospitalization (HR, 1.64; 95%CI, 1.37-1.96; P<0.0001), and total HF hospitalizations (rate ratio [RR], 1.89; 95%CI, 1.51-2.36; P<0.0001). Presence of congestion was also associated with a significantly higher risk for each of these outcomes (HR 1.52, 1.94, and RR 2.03, respectively). Empagliflozin reduced the risk for first (HR 0.77, 95%CI 0.60-0.98) and total (RR 0.67, 95%CI 0.50-0.89) HF hospitalization, irrespective of LVEF or congestion or both. The safety profile of empagliflozin was consistent across baseline LVEF and irrespective of congestion status. Conclusions In patients with AMI, severity of LV dysfunction and the presence of congestion was associated with worse outcomes. Empagliflozin reduced first and total HF hospitalizations across the range of LVEF with and without congestion.
Item Type: | Articles |
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Additional Information: | Funding Support: Boehringer Ingelheim and Eli Lilly and Company. |
Keywords: | acute myocardial infarction; left ventricular dysfunction; congestion; heart failure; empagliflozin |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Petrie, Professor Mark |
Authors: | Udell, J. A., Petrie, M. C., Jones, W. S., Anker, S. D., Harrington, J., Mattheus, M., Seide, S., Amir, O., Bahit, M. C., Bauersachs, J., Bayes-Genis, A., Chen, Y., Chopra, V. K., Figtree, G., Ge, J., Goodman, S. G., Gotcheva, N., Goto, S., Gasior, T., Jamal, W., Januzzi, J. L., Jeong, M. H., Lopatin, Y., Lopes, R. D., Merkely, B., Martinez-Traba, M., 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., Hernandez, A. F., and Butler, J. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Journal of the American College of Cardiology |
Publisher: | Elsevier for the American College of Cardiology |
ISSN: | 0735-1097 |
ISSN (Online): | 1558-3597 |
Published Online: | 01 April 2024 |
Copyright Holders: | Copyright: © 2024 The Authors |
First Published: | First published in Journal of the American College of Cardiology 2024 |
Publisher Policy: | Reproduced under a Creative Commons licence |
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