Related Experiment Video
Updated: Apr 30, 2026
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Early eplerenone treatment in patients with acute ST-elevation myocardial infarction without heart failure: the
Gilles Montalescot1, Bertram Pitt2, Esteban Lopez de Sa3
1Institut de Cardiologie, Centre Hospitalier Pitié-Salpêtrière (AP-HP, ACTION Group, University Paris 6), 47 boulevard de l'Hôpital, 75013 Paris, France gilles.montalescot@psl.aphp.fr.
Insights
Eplerenone initiation within 24 hours of STEMI in patients without heart failure significantly reduced cardiovascular events. This early treatment was safe and well-tolerated, primarily due to lower BNP/NT-proBNP levels.
Area of Science:
- Cardiology
- Pharmacology
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt intervention.
- Mineralocorticoid receptor antagonists (MRAs) are established treatments for heart failure.
- The role of early MRA use in STEMI patients without pre-existing heart failure remains under investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of early eplerenone administration in STEMI patients without heart failure.
- To assess the impact of eplerenone on composite cardiovascular outcomes.
Main Methods:
- A randomized, placebo-controlled, double-blind trial involving 1012 STEMI patients without heart failure.
- Patients received standard therapy plus either eplerenone (25-50 mg daily) or placebo, initiated within 24 hours of symptom onset.
- The primary endpoint was a composite of cardiovascular mortality, re-hospitalization, or extended hospital stay due to heart failure, sustained ventricular tachycardia/fibrillation, low ejection fraction, or elevated BNP/NT-proBNP levels.
Main Results:
- The primary composite endpoint occurred in 18.2% of the eplerenone group versus 29.4% in the placebo group (adjusted HR, 0.58; P < 0.0001).
- The reduction in the primary endpoint was largely driven by significantly lower BNP/NT-proBNP levels in the eplerenone group.
- Adverse event rates were similar between groups, with no significant difference in hyperkalemia, though hypokalemia was less frequent with eplerenone.
Conclusions:
- Early administration of eplerenone in acute STEMI patients without heart failure is safe and well-tolerated.
- Eplerenone significantly reduces major adverse cardiovascular events, primarily through lowering natriuretic peptide levels.
- Further research is warranted to define the optimal role of early MRAs in this patient population.
Aims:
We aimed to assess the impact of eplerenone on cardiovascular (CV) outcomes in STEMI without known heart failure, when initiated within 24 h of symptom onset.
Methods And Results:
In this randomized, placebo-controlled, double-blind trial, we assigned 1012 patients with acute STEMI and without a history of heart failure to receive either eplerenone (25-50 mg once daily) or placebo in addition to standard therapy. The primary endpoint was the composite of CV mortality, re-hospitalization, or, extended initial hospital stay, due to diagnosis of HF, sustained ventricular tachycardia or fibrillation, ejection fraction ≤40%, or elevated BNP/NT-proBNP at 1 month or more after randomization. BNP elevation was defined as BNP levels or values above 200 pg/mL or NT-proBNP values above 450 pg/mL (in patients aged below 50); above 900 pg/mL (age 50-75 years) or above 1800 pg/mL (patients older than 75). After a mean follow-up of 10.5 months, the primary endpoint occurred in 92 patients (18.2%) in the eplerenone group and in 149 patients (29.4%) in the placebo group [adjusted hazard ratio (HR), 0.58; 95% confidence interval (CI), 0.45-0.76; P < 0.0001]. The primary endpoint was driven by a high BNP/NT-proBNP level (adjusted HR, 0.60; 95% CI, 0.45-0.79; P < 0.0003). Adverse event rates were similar in both groups. Serum potassium levels exceeded 5.5 mmol/L in 5.6 vs. 3.2% (P = 0.09) and were below 3.5 mmol/L in 1.4 vs. 5.6% of patients (P = 0.0002), in the eplerenone and placebo groups, respectively.
Conclusion:
The addition of eplerenone during the acute phase of STEMI was safe and well tolerated. It reduced the primary endpoint over a mean 13 months follow-up mostly because of significantly lower BNP/NT-proBNP levels. Additional studies are needed to clarify the role of early use of MRAs in STEMI patients without heart failure.
Clinical Trial Registration:
NCT01176968.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Heart Failure V: Medical Management
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
01:14Myocarditis III: Medical Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Antihypertensive Drugs: Direct Renin Inhibitors