Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial
Por:
Hernandez, AF, Udell, JA, Jones, WS, Anker, SD, Petrie, MC, Harrington, J, Mattheus, M, Seide, S, Zwiener, I, Amir, O, Bahit, MC, Bauersachs, J, Bayes-Genis, A, Chen, YD, Chopra, VK, Figtree, GA, Ge, JB, Goodman, SG, Gotcheva, N, Goto, S, Gasior, T, Jamal, W, Januzzi, JL, Jeong, MH, Lopatin, Y, Lopes, RD, Merkely, B, Parikh, PB, Parkhomenko, A, Ponikowski, P, Rossello, X, Schou, M, Simic, D, Steg, PG, Szachniewicz, J, van der Meer, P, Vinereanu, D, Zieroth, S, Brueckmann, M, Sumin, M, Bhatt, DL and Butler, J
Publicada:
21 may 2024
Resumen:
BACKGROUND: Empagliflozin reduces the risk of heart failure (HF) events in patients with type 2 diabetes at high cardiovascular risk, chronic kidney disease, or prevalent HF irrespective of ejection fraction. Whereas the EMPACT-MI trial (Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients With Acute Myocardial Infarction) showed that empagliflozin does not reduce the risk of the composite of hospitalization for HF and all-cause death, the effect of empagliflozin on first and recurrent HF events after myocardial infarction is unknown.
METHODS: EMPACT-MI was a double-blind, randomized, placebo-controlled, event-driven trial that randomized 6522 patients hospitalized for acute myocardial infarction at risk for HF on the basis of newly developed left ventricular ejection fraction of <45% or signs or symptoms of congestion to receive empagliflozin 10 mg daily or placebo within 14 days of admission. In prespecified secondary analyses, treatment groups were analyzed for HF outcomes.
RESULTS: Over a median follow-up of 17.9 months, the risk for first HF hospitalization and total HF hospitalizations was significantly lower in the empagliflozin compared with the placebo group (118 [3.6%] versus 153 [4.7%] patients with events; hazard ratio, 0.77 [95% CI, 0.60, 0.98]; P=0.031, for first HF hospitalization; 148 versus 207 events; rate ratio, 0.67 [95% CI, 0.51, 0.89]; P=0.006, for total HF hospitalizations). Subgroup analysis showed consistency of empagliflozin benefit across clinically relevant patient subgroups for first and total HF hospitalizations. The need for new use of diuretics, renin-angiotensin modulators, or mineralocorticoid receptor antagonists after discharge was less in patients randomized to empagliflozin versus placebo (all P<0.05).
CONCLUSIONS: Empagliflozin reduced the risk of HF in patients with left ventricular dysfunction or congestion after acute myocardial infarction.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04509674.
Filiaciones:
Hernandez, AF:
Duke Univ, Div Cardiol, Dept Med, Durham, NC USA
Duke Clin Res Inst, 300 W Morgan St, Durham, NC 27701 USA
Udell, JA:
Univ Toronto, Toronto Gen Hosp, Womens Coll Hosp, Toronto, ON, Canada
Univ Toronto, Toronto Gen Hosp, Peter Munk Cardiac Ctr, Toronto, ON, Canada
Jones, WS:
Duke Univ, Div Cardiol, Dept Med, Durham, NC USA
Duke Clin Res Inst, 300 W Morgan St, Durham, NC 27701 USA
Anker, SD:
Charite Univ Med Berlin, Berlin Inst Hlth Ctr Regenerat Therapies BCRT, Dept Cardiol CVK,German Heart Ctr Charite, German Ctr Cardiovasc Res DZHK,Partner Site B, Berlin, Germany
Petrie, MC:
Univ Glasgow, Sch Cardiovasc & Med Sci, British Heart Fdn Glasgow Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
Harrington, J:
Duke Univ, Div Cardiol, Dept Med, Durham, NC USA
Duke Clin Res Inst, 300 W Morgan St, Durham, NC 27701 USA
Mattheus, M:
Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
Seide, S:
Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
Zwiener, I:
Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
Amir, O:
Hebrew Univ Jerusalem, Inst Heart, Hadassah Med Ctr, Jerusalem, Israel
Bahit, MC:
Fdn INECO, INECO Neurociencias Orono, Rosario, Santa Fe, Argentina
Bauersachs, J:
Hannover Med Sch, Dept Cardiol & Angiol, Hannover, Germany
:
Hosp Badalona Germans Trias & Pujol, Inst Heart, Barcelona, Spain
Univ Autnomoa Barcelona, Dept Med, Barcelona, Spain
Chen, YD:
Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Med Ctr 1, Beijing, Peoples R China
Chopra, VK:
Max Super Special Hosp, Saket, New Delhi, India
Figtree, GA:
Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia
Ge, JB:
Fudan Univ, Shanghai Inst Cardiovasc Dis, Zhongshan Hosp, Dept Cardiol,Natl Clin Res Ctr Intervent Med, Shanghai, Peoples R China
Goodman, SG:
Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada
Univ Toronto, Dept Med, St Michaels Hosp, Div Cardiol,Unity Hlth Toronto, Toronto, ON, Canada
Gotcheva, N:
MHAT Natl Cardiol Hosp EAD, Dept Cardiol, Sofia, Bulgaria
Goto, S:
Tokai Univ, Dept Med Cardiol, Sch Med, Isehara, Kanagawa, Japan
Gasior, T:
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
WSB Univ, Coll Med, Fac Med, Dabrowa Gornicza, Poland
Jamal, W:
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
Januzzi, JL:
Harvard Med Sch, Div Cardiol, Boston, MA USA
Massachusetts Gen Hosp, Boston, MA USA
Jeong, MH:
Chonnam Natl Univ Hosp & Med Sch, Gwangju, South Korea
Lopatin, Y:
Volgograd State Med Univ, Volgograd, Russia
Lopes, RD:
Duke Univ, Div Cardiol, Dept Med, Durham, NC USA
Duke Clin Res Inst, 300 W Morgan St, Durham, NC 27701 USA
Merkely, B:
Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary
Parikh, PB:
SUNY Stony Brook, Div Cardiovasc Med, Dept Med, Stony Brook, NY USA
Parkhomenko, A:
AMS Ukraine, Ukrainian Inst Cardiol MD Strazhesko, Kyiv, Ukraine
Ponikowski, P:
Wroclaw Med Univ, Inst Heart Dis, Wroclaw, Poland
Rossello, X:
Univ Balear Islands, Hlth Res Inst Balear Islands, Hosp Univ Son Espases, Palma De Mallorca, Spain
Schou, M:
Herlev & Gentofte Univ Hosp, Dept Cardiol, Copenhagen, Denmark
Simic, D:
Univ Clin Ctr Belgrade, Dept Cardiovasc Dis, Belgrade, Serbia
Steg, PG:
Univ Paris Cite, Hop Bichat, AP HP,U 1148, INSERM,FACT French Alliance Cardiovasc Trials, Paris, France
Szachniewicz, J:
Jan Mikulicz Radecki Univ Clin Hosp, Wroclaw, Poland
van der Meer, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
Vinereanu, D:
Univ Med & Pharm Carol Davila, Univ & Emergency Hosp, Bucharest, Romania
Zieroth, S:
Univ Manitoba, Sect Cardiol, Max Rady Coll Med, Winnipeg, MB, Canada
Brueckmann, M:
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
Heidelberg Univ, Fac Med Mannheim, Dept Med 1, Mannheim, Germany
Sumin, M:
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
Bhatt, DL:
Icahn Sch Med Mt Sinai, Mt Sinai Fuster Heart Hosp, New York, NY USA
Butler, J:
Baylor Scott & White Res Inst, Dallas, TX USA
Univ Mississippi, Dept Med, Jackson, MS USA
Green Published
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