The aldosterone antagonist eplerenone was evaluated in the EPHESUS trial leading to the recommendation for their with an ACE inhibitor prior to hospital discharge after UA/NSTEMI if there is left ventricular systolic dysfunction (EF < 40%) and either diabetes or symptomatic heart failure present and no contraindication (serum creatinine > 2.5 and or potassium > 5.0). A class effect is likely present and thus spironolactone is frequently used instead of eplerenone due to cost concerns, although there is no direct data to support this practice.