Eplerenone Effective After MI in Patients with LVSD and Heart Failure

But should eplerenone have preferential status as first therapy?

In the RALES randomized trial, the aldosterone antagonist spironolactone improved outcomes in patients with severe heart failure (HF) and left-ventricular systolic dysfunction (LVSD; N Engl J Med 1999; 341:709). Now, in an industry-sponsored, randomized, placebo-controlled trial, researchers have assessed whether another aldosterone antagonist, eplerenone, improves outcomes 3 to 14 days after MI in patients with LV ejection fractions ≤40% and HF or diabetes. Subjects were 6632 patients from 674 centers in 37 countries.

Patients with creatinine concentrations >2.5 mg/dL or potassium concentrations >5.0 mmol/L were excluded. At baseline, 88% of patients were receiving aspirin, 87% ACE inhibitors, 75% beta-blockers, and 60% diuretics. Mean foll…

Reviewing Author

Harlan M. Krumholz, MD, SM