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Adjunctive treatment with eplerenone reduced morbidity and mortality in acute myocardial infarction

Key Words: myocardial infarction • receptors (aldosterone) • spironolactone • ventricular dysfunction

The first 150 words of the full text of this article appear below.

Design
Randomised {allocation concealed^*}, blinded (clinicians, patients, outcome assessors, {data collectors, data analysts, and manuscript writers}),^* placebo controlled trial with mean 16 months of follow up (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study [EPHESUS]).

Setting
674 centres in 37 countries.

Patients
6642 patients (mean age 64 y, 71% men) with acute MI, left ventricular dysfunction (ejection fraction 40%), and HF (confirmed by the presence of pulmonary rales, pulmonary venous congestion on chest radiography, or a third heart sound). Exclusion criteria included potassium sparing diuretics, serum creatinine 220 µmol/l, and serum potassium >5.0 mmol/l before randomisation. 6632 patients (99.8%) were included in the follow up analysis.

Intervention
Patients were stratified by clinical site and allocated 3–14 days after acute MI to eplerenone, 25 mg/day (increased to a maximum of 50 mg/d after 4 wk) (n=3319) or placebo (n=3313). All patients received optimal medical treatment (angiotensin converting enzyme inhibitors, angiotensin . . . [Full text of this article]

Manu Prabhakar, MD, David Massel, MD

London Health Sciences Centre, London, Ontario, Canada