OBJECTIVES: This study sought to assess the impact of the selective aldosterone blocker eplerenone on mortality 30 days after randomization in patients after acute myocardial infarction(AMI) with a left ventricular ejection fraction(LVEF) ≤40%and clinical signs of heart failure. BACKGROUND: In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study(EPHESUS), eplerenone reduced all-cause mortality by 15%(p=0.008) over a mean followup of 16 months when used with standard therapy in patients after AMI with an LVEF ≤40%and clinical signs of heart failure. METHODS: We analyzed the effect of eplerenone 25 mg/day initiated 3 to 14 days after AMI(mean, 7.3 days) on the co-primary end points of time to death from any cause and the composite end point of time to death from cardiovascular(CV) causes or hospitalization for CV events, and the secondary end points of CV mortality, sudden cardiac death, and fatal/nonfatal hospitalization for heart failure, after 30 days of therapy in the EPHESUS trial. RESULTS: At 30 days after randomization, eplerenone reduced the risk of all-cause mortality by 31%(3.2%vs. 4.6%in eplerenone and placebo-treated patients, respectively; p=0.004) and reduced the risk of CV mortality/CV hospitalization by 13%(8.6%vs. 9.9%in eplerenone and placebo-treated patients, respectively; p=0.074). Eplerenone also reduced the risk of CV mortality by 32%(p=0.003) and the risk of sudden cardiac death by 37%(p=0.051). CONCLUSIONS: Eplerenone 25 mg/day significantly reduced all-cause mortality 30 days after randomization(when initiated at a mean of 7.3 days after AMI) in addition to conventional therapy in patients with an LVEF ≤40%and signs of heart failure. Based on its early survival benefit, eplerenone should be administered in the hospital after AMI.
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