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

https://doi.org/10.1136/ebm.8.5.146

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    (2003) N Engl J Med 348, 1309. Pitt B, Remme W, Zannad F, et al.. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.. ;. :. –21.
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 QUESTION: In patients with acute myocardial infarction (MI) complicated by left ventricular dysfunction and congestive heart failure (CHF), does adjunctive treatment with eplerenone reduce morbidity and mortality more than placebo?

    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 …

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    Footnotes

    • Source of funding: Pharmacia.

    • For correspondence: Dr B Pitt, University of Michigan, Ann Arbor, MI, USA. bpitt{at}umich.edu

    • Abstract and commentary also appear in ACP Journal Club.

    • ↵* See glossary.

    • ↵† Information provided by author.