Abstract 2496: Eplerenone Attenuates Left Ventricular Remodeling after Acute Myocardial Infarction in Patients with Left Ventricular Systolic Dysfunction
Introduction: Eplerenone reduces morbidity and mortality in patients with left ventricular systolic dysfunction (LVSD) and heart failure (HF) or diabetes, after acute myocardial infarction (AMI). To determine whether eplerenone might have a broader indication after AMI we performed a cardiac magnetic resonance imaging (CMR) study to assess the effect of this agent on left ventricular (LV) remodeling in patients with AMI and LVSD but without HF or diabetes.
Methods: 100 patients with AMI (LV ejection fraction <40% on echocardiography) underwent CMR and serum BNP and NTproBNP sampling at a mean 4.2 days after AMI; they were then randomised (double-blinded) to eplerenone or placebo. CMR and bloods were repeated at 6 months; study drug was then withdrawn. The primary end-point was change in LV end-systolic volume index (LVESVI). Analysis was by intention to treat, with a prespecified covariate adjustment to take account of any baseline imbalances.
Results: Mean age ± SD was 58.9 ± 12.0 yrs (77% male). 78% underwent revascularisation before randomisation, 93% were discharged on a beta blocker and 94% on an ACE inhibitor. There were significant baseline imbalances between the two groups. We used a stepwise selection model to detect the baseline variables that were prognostic of LVESVI at 6 months, to which were added all variables that had a trend to imbalance (p < 0.1) at baseline. After adjusting for these covariates (Table 1⇓), the treatment effect of eplerenone on LVESVI over 6 months was -6.1 ± 2.7ml/m2 (p = 0.027). There were no significant between treatment-group differences in change in NTproBNP (-1876 ± 1551 [eplerenone] v -1616 ±2212 pg/ml [placebo], p = 0.512) or BNP (-148 ±130 [eplerenone] v -96 ± 208 pg/ml [placebo], p = 0.155) from baseline to 6 months.
Conclusion: In a population of AMI patients with a very high uptake of contemporary anti-remodelling therapy and a high revascularisation rate, eplerenone significantly attenuated LV remodeling after AMI in patients with LVSD.