Acronym: Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study
Purpose: To evaluate the use of eplerenone (aldosterone antogonist) after acute myocardial infarctions with there is left ventricular systolic dysfunction (EF < 40%) and heart failure or diabetes.
Format: Double-blind, multicenter, randomized control trial
Treatment Group: Eplerenone
Control Group: Placebo
Number of Patients: 6,452
Acute myocardial infarction
Left ventricular dysfunction with EF < 40%
Congestive heart failure symptoms, chest x-ray findings or an S3 heart sound
Diabetes mellitus type II with left ventricular dysfunction even if no heart failure symptoms present
Use of potassium sparing diuretics (spironolactone, triamterene)
Creatnine > 2.5 mg/dL
Potassium level > 5.0 mmol/L
Follow-up: Mean 16 months
Time to death from any cause
Composite of time to death from cardiovascular cause and hospitalization for cardiovascular event
Evaluated eplerenone versus placebo in patients with acute myocardial infarctions, left ventricular dysfunction (EF < 40%) and heart failure symptoms OR left ventricular dysfunction and diabetes without heart failure symptoms. Eplerenone had a 16% relative risk reduction in cardiovascular death and hospitalizations for cardiovascular events. There was a 8% relative risk reduction in all-cause mortality and a 21% relative risk reduction of sudden death from cardiac causes. There was an increased risk of serious hyperkalemia.
Pitt B, et al. N Engl J Med. 2003;doi:10.1056/NEJMoa030207.