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Eplerenone improved CV outcomes in STEMI patients
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SAN FRANCISCO — Early addition of eplerenone to standard therapy reduced the risk for CV mortality, clinical or subclinical HF, and severe ventricular arrhythmias by 40% when administered within the first 24 hours of symptom onset, according to data from the REMINDER trial.
Researchers studied 1,012 patients with acute STEMI without history of HF and ongoing HF. Patients were assigned eplerenone (25 mg to 50 mg) or placebo in addition to standard therapy.
The primary endpoint of the trial was time to first event of CV mortality, rehospitalization or extended initial hospital stay due to HF, sustained ventricular tachycardia or fibrillation, ejection fraction ≤ 40 after 1 month or elevation of brain natriuretic peptide/NT-proBNP after 1 month.
"After a mean follow-up of 10.5 months, the primary endpoint was reduced from 29% to 18%. This was highly significant," Gilles Montalescot, MD, PhD, head of the cardiac care unit at Pitié-Salpêtrière Hospital, Paris, said at a press conference.
Gilles Montalescot
"The primary endpoint was mainly driven by patients with BNP levels. Hyperkalemia was not significant between the two groups,” he said. After 1 month, 16% of patients assigned eplerenone had an elevation of BNP/NT-proBNP compared with 25.9% assigned placebo (P<.0002).
Adverse events rates were similar in both groups. Hyperkalemia (>5.5 mEq/L) was not significantly different between the two groups, but hypokalemia was significantly reduced with eplerenone (1.4% vs 5.6%), according to data presented.
"Eplerenone has the potential to reduce clinical and subclinical HF in STEMI patients," Montalescot stated in a press release. "Confirmation in a higher-risk population with longer follow-up would be important to support this new strategy." – by Deb Dellapena
For more information:
Montalescot G. Poster #13-LB-15932-ACC. Presented at: American College of Cardiology Scientific Sessions; March 9-11, 2013; San Francisco.
Disclosure: The study was funded by Pfizer. Montalescot reports no relevant financial disclosures.
Perspective
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Miguel A. Quiñones, MD, MACC
This trial is based on a very solid hypothesis. It would be great to study these patients for 3 to 5 years; what would be the gain of a lower clinical incidence of HF in the years to come?
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