March 10th, 2013

Eplerenone May Help Prevent Heart Failure in Acute STEMI Patients

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A new trial presented at the ACC in San Francisco suggests that the mineralocorticoid-receptor antagonist eplerenone (Pfizer, Inspra) may help prevent the development of heart failure when given acutely to STEMI patients without preexisting heart failure.

In the REMINDER trial, 1012 STEMI patients were randomized to receive eplerenone or placebo. After 10.5 months of follow-up, the primary endpoint — the time to CV mortality, rehospitalization or extended initial hospital stay due to diagnosis of HF, sustained ventricular tachycardia or fibrillation, LVEF ≤40% after 1 month, or an elevation of BNP/NT-proBNP after 1 month — occurred in 18.4% of the eplerenone group versus 29.6% of the placebo group (adjusted HR, 0.581; 95% CI, 0.449-0.753; P<0.0001).

BNP elevations occurred in 16% of the eplerenone group versus 25.9% of the placebo group (adjusted HR; 0.584; 95% CI, 0.441-0.773; P<0.0002). Significantly more patients in the eplerenone group had elevasted or low levels of potassium, but the overall rate of adverse events was similar in both groups.

The authors concluded that “the early addition of eplerenone to standard therapy has a beneficial effect on heart failure related morbidity in patients presenting with acute STEMI without HF when initiated within the first 24 hours of symptom onset.”

“This is the first randomized trial to test a mineralocorticoid receptor agonist during the acute phase of heart attack, and the results suggest a clinical benefit,” said Gilles Montalescot, lead investigator of the study, in an ACC press release.

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