Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction
Por:
Udell, JA, Petrie, MC, Jones, WS, Anker, SD, Harrington, J, Mattheus, M, Seide, S, Amir, O, Bahit, MC, Bauersachs, J, Bayes-Genis, A, Chen, YD, Chopra, VK, Figtree, G, Ge, JB, Goodman, SG, Gotcheva, N, Goto, S, Gasior, T, Jamal, W, Januzzi, JL, Jeong, MH, Lopatin, Y, Lopes, RD, Merkely, B, Martinez-Traba, M, Parikh, PB, Parkhomenko, A, Ponikowski, P, Rossello, X, Schou, M, Simic, D, Steg, PG, Szachniewicz, J, Meer, PV, Vinereanu, D, Zieroth, S, Brueckmann, M, Sumin, M, Bhatt, DL, Hernandez, AF and Butler, J
Publicada:
11 jun 2024
Ahead of Print:
1 jun 2024
Resumen:
BACKGROUND Empagli flozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI). OBJECTIVES This study sought to evaluate the association of left ventricular ejection fraction (LVEF), congestion, or both, with outcomes and the impact of empagli flozin in reducing HF risk post-AMI. METHODS In the EMPACT-MI (Trial to Evaluate the Effect of Empagli flozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction) trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF < 45%, congestion, or both, to empagli flozin (10 mg daily) or placebo and were followed up for a median of 17.9 months. RESULTS Among 6,522 patients, the mean baseline LVEF was 41 +/- 9%; 2,648 patients (40.6%) presented with LVEF < 45% alone, 1,483 (22.7%) presented with congestion alone, and 2,181 (33.4%) presented with both. Among patients in the placebo arm of the trial, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause death or HF hospitalization (HR: 1.49; 95% CI: 1.31-1.69; P < 0.0001), first HF hospitalization (HR: 1.64; 95% CI: 1.371.96; P < 0.0001), and total HF hospitalizations (rate ratio [RR]: 1.89; 95% CI: 1.51-2.36; P < 0.0001). The presence of congestion was also associated with a signi ficantly higher risk for each of these outcomes (HR: 1.52, 1.94, and RR: 2.03, respectively). Empagli flozin reduced the risk for first (HR: 0.77; 95% CI: 0.60-0.98) and total (RR: 0.67; 95% CI: 0.500.89) HF hospitalizations, irrespective of LVEF or congestion, or both. The safety pro file of empagli flozin was consistent across baseline LVEF and irrespective of congestion status. CONCLUSIONS In patients with AMI, the severity of left ventricular dysfunction and the presence of congestion was associated with worse outcomes. Empagli flozin reduced first and total HF hospitalizations across the range of LVEF with and without congestion.
Filiaciones:
Udell, JA:
Univ Toronto, Womens Coll Hosp, Toronto, ON, Canada
Univ Toronto, Toronto Gen Hosp, Peter Munk Cardiac Ctr, Toronto, ON, Canada
Petrie, MC:
Univ Glasgow, British Heart Fdn, Sch Cardiovasc & Med Sci, Glasgow Cardiovasc Res Ctr, Glasgow, Scotland
Jones, WS:
Duke Univ, Dept Med, Div Cardiol, Durham, NC USA
Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC USA
Anker, SD:
Charite, German Heart Ctr Charite, Dept Cardiol, Berlin, Germany
Charite, Berlin Inst Hlth Ctr Regenerat Therapies, German Ctr Cardiovasc Res, Partner Site Berlin, Berlin, Germany
Harrington, J:
Duke Univ, Dept Med, Div Cardiol, Durham, NC USA
Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC USA
Mattheus, M:
Boehringer Ingelheim Pharm GmbH & Co KG, Ingelheim, Germany
Seide, S:
Boehringer Ingelheim Pharm GmbH & Co KG, Ingelheim, Germany
Amir, O:
Hebrew Univ Jerusalem, Heart Inst, Hadassah Med Ctr, Jerusalem, Israel
Bahit, MC:
Fdn INECO, INECO Neurociencias Oron, Rosario, Santa Fe, Argentina
Bauersachs, J:
Hannover Med Sch, Dept Cardiol & Angiol, Hannover, Germany
:
Hosp Univ Germans Trias i Pujol, Heart Inst, Barcelona, Spain
Univ Autonomoa Barcelona, Dept Med, Barcelona, Spain
Chen, YD:
Chinese Peoples Liberat Army Gen Hosp, Med Ctr 1, Dept Cardiol, Beijing, Peoples R China
Chopra, VK:
Max Super Special Hosp, New Delhi, India
Figtree, G:
Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia
Ge, JB:
Fudan Univ, Zhongshan Hosp, Shanghai Inst Cardiovasc Dis, Natl Clin Res Ctr Intervent Med,Dept Cardiol, Shanghai, Peoples R China
Goodman, SG:
Univ Toronto, Toronto Gen Hosp, Peter Munk Cardiac Ctr, Toronto, ON, Canada
Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada
Unity Hlth Toronto, St Michaels Hosp, Dept Med, Div Cardiol, Toronto, ON, Canada
Gotcheva, N:
MHAT Natl Cardiol Hosp EAD, Dept Cardiol, Sofia, Bulgaria
Goto, S:
Tokai Univ, Sch Med, Dept Med Cardiol, Isehara, Japan
Gasior, T:
WSB Univ, Fac Med, Coll Med, Dabrowa Gornicza, Poland
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
Jamal, W:
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
Januzzi, JL:
Harvard Med Sch, Div Cardiol, Boston, MA USA
Massachusetts Gen Hosp, Boston, MA USA
Baim Inst Clin Res, Heart Failure & Biomarker Trials, Boston, MA USA
Jeong, MH:
Chonnam Natl Univ Hosp, Gwangju, South Korea
Med Sch, Gwangju, South Korea
Lopatin, Y:
Volgograd State Med Univ, Volgograd, Russia
Lopes, RD:
Duke Univ, Dept Med, Div Cardiol, Durham, NC USA
Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC USA
Merkely, B:
Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary
Martinez-Traba, M:
Boehringer Ingelheim Int GmbH, Ingelheim, Germany
Parikh, PB:
SUNY Stony Brook, Dept Med, Div Cardiovasc Med, Stony Brook, NY USA
Parkhomenko, A:
AMS Ukraine, MD Strazhesko Ukrainian Inst Cardiol, Kiev, Ukraine
Ponikowski, P:
Wroclaw Med Univ, Inst Heart Dis, Wroclaw, Poland
Rossello, X:
Univ Balear Isl, Hosp Univ Son Espases, Hlth Res Inst Balear Isl, Palma De Mallorca, Spain
Schou, M:
Herlev & Gentofte Univ Hosp, Dept Cardiol, Copenhagen, Denmark
Simic, D:
Univ Clin Ctr, Dept Cardiovasc Dis, Belgrade, Serbia
Steg, PG:
Univ Paris Cite, Hop Bichat, AP HP, INSERM U 1148,FACT French Alliance Cardiovasc Tria, Paris, France
Szachniewicz, J:
Jan Mikulicz Radecki Univ Clin Hosp, Wroclaw, Poland
Meer, PV:
Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
Vinereanu, D:
Univ Med & Pharm Carol Davila, Univ & Emergency Hosp Bucharest, Bucharest, Romania
Zieroth, S:
Univ Manitoba, Max Rady Coll Med, Sect Cardiol, Winnipeg, MB, Canada
Brueckmann, M:
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
Hernandez, AF:
Duke Univ, Dept Med, Div Cardiol, Durham, NC USA
Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC USA
Butler, J:
Baylor Scott & White Res Inst, Dallas, TX USA
Univ Mississippi, Dept Med, Jackson, MS USA
Green Published, hybrid, Green Accepted
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