@article{20.500.13003/20330,
year = {2024},
month = {4},
url = {https://hdl.handle.net/20.500.13003/20330},
abstract = {Empagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI).
This study sought to evaluate the association of left ventricular ejection fraction (LVEF), congestion, or both, with outcomes and the impact of empagliflozin in reducing HF risk post-AMI.
In the EMPACT-MI (Trial to Evaluate the Effect of Empagliflozin 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 empagliflozin (10 mg daily) or placebo and were followed up for a median of 17.9 months.
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: 1.37-1.96; 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 significantly higher risk for each of these outcomes (HR: 1.52, 1.94, and RR: 2.03, respectively). Empagliflozin reduced the risk for first (HR: 0.77; 95% CI: 0.60-0.98) and total (RR: 0.67; 95% CI: 0.50-0.89) HF hospitalizations, irrespective of LVEF or congestion, or both. The safety profile of empagliflozin was consistent across baseline LVEF and irrespective of congestion status.
In patients with AMI, the severity of left ventricular dysfunction and the presence of congestion was associated with worse outcomes. Empagliflozin reduced first and total HF hospitalizations across the range of LVEF with and without congestion. (Trial to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction [EMPACT-MI]; NCT04509674).},
publisher = {Elsevier},
title = {Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction},
doi = {10.1016/j.jacc.2024.03.405},
journal = {Journal of the American College of Cardiology},
keywords = {acute myocardial infarction},
keywords = {congestion},
keywords = {empagliflozin},
keywords = {heart failure},
keywords = {left ventricular dysfunction},
author = {Udell, Jacob A and Petrie, Mark C and Jones, W Schuyler and Anker, Stefan D and Harrington, Josephine and Mattheus, Michaela and Seide, Svenja and Amir, Offer and Bahit, M Cecilia and Bauersachs, Johann and Bayes-Genis, Antoni and Chen, Yundai and Chopra, Vijay K and Figtree, Gemma and Ge, Junbo and Goodman, Shaun G and Gotcheva, Nina and Goto, Shinya and Gasior, Tomasz and Jamal, Waheed and Januzzi, James L and Jeong, Myung Ho and Lopatin, Yuri and Lopes, Renato D and Merkely, Béla and Martinez-Traba, Monica and Parikh, Puja B and Parkhomenko, Alexander and Ponikowski, Piotr and Rosselló, Xavier and Schou, Morten and Simic, Dragan and Steg, Philippe Gabriel and Szachniewicz, Joanna and van der Meer, Peter and Vinereanu, Dragos and Zieroth, Shelley and Brueckmann, Martina and Sumin, Mikhail and Bhatt, Deepak L and Hernandez, Adrian F and Butler, Javed},
}