Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial

• Published in: Circulation Vol. 149; no. 21; pp. 1627 - 1638
• Main Authors: Hernandez, Adrian F., Udell, Jacob A., Jones, W. Schuyler, Anker, Stefan D., Petrie, Mark C., Harrington, Josephine, Mattheus, Michaela, Seide, Svenja, Zwiener, Isabella, Amir, Offer, Bahit, M. Cecilia, Bauersachs, Johann, Bayes-Genis, Antoni, Chen, Yundai, Chopra, Vijay K., A. Figtree, Gemma, Ge, Junbo, G. Goodman, Shaun, Gotcheva, Nina, Goto, Shinya, Gasior, Tomasz, Jamal, Waheed, Januzzi, James L., Jeong, Myung Ho, Lopatin, Yuri, Lopes, Renato D., Merkely, Béla, Parikh, Puja B., Parkhomenko, Alexander, Ponikowski, Piotr, Rossello, Xavier, Schou, Morten, Simic, Dragan, Steg, Philippe Gabriel, Szachniewicz, Joanna, van der Meer, Peter, Vinereanu, Dragos, Zieroth, Shelley, Brueckmann, Martina, Sumin, Mikhail, Bhatt, Deepak L., Butler, Javed
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Ovid Technologies (Wolters Kluwer Health) 21.05.2024; Lippincott Williams & Wilkins
• Subjects: Aged; Anciano; Benzhydryl Compounds; Benzhydryl Compounds - therapeutic use; Compuestos de Bencidrilo; Double-Blind Method; Female; Femenino; Glucosides; Glucosides - therapeutic use; Glucósidos; Heart Failure; Heart Failure - drug therapy; Heart Failure - mortality; Hospitalización; Hospitalization; Humanos; Humans; Infarto del Miocardio; Inhibidores del Cotransportador de Sodio-Glucosa 2; Insuficiencia Cardíaca; Male; Masculino; Middle Aged; Myocardial Infarction; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Método Doble Ciego; Original Research Articles; Original s; Persona de Mediana Edad; Resultado del Tratamiento; Sodium-Glucose Transporter 2 Inhibitors; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stroke Volume; Stroke Volume - drug effects; Treatment Outcome; Volumen Sistólico; hospitalization; heart failure; myocardial infarction
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/circulationaha.124.069217

BACKGROUND: Empagliflozin reduces the risk of heart failure (HF) events in patients with type 2 diabetes at high cardiovascular risk, chronic kidney disease, or prevalent HF irrespective of ejection fraction. Whereas the EMPACT-MI trial (Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients With Acute Myocardial Infarction) showed that empagliflozin does not reduce the risk of the composite of hospitalization for HF and all-cause death, the effect of empagliflozin on first and recurrent HF events after myocardial infarction is unknown. METHODS: EMPACT-MI was a double-blind, randomized, placebo-controlled, event-driven trial that randomized 6522 patients hospitalized for acute myocardial infarction at risk for HF on the basis of newly developed left ventricular ejection fraction of <45% or signs or symptoms of congestion to receive empagliflozin 10 mg daily or placebo within 14 days of admission. In prespecified secondary analyses, treatment groups were analyzed for HF outcomes. RESULTS: Over a median follow-up of 17.9 months, the risk for first HF hospitalization and total HF hospitalizations was significantly lower in the empagliflozin compared with the placebo group (118 [3.6%] versus 153 [4.7%] patients with events; hazard ratio, 0.77 [95% CI, 0.60, 0.98]; P=0.031, for first HF hospitalization; 148 versus 207 events; rate ratio, 0.67 [95% CI, 0.51, 0.89]; P=0.006, for total HF hospitalizations). Subgroup analysis showed consistency of empagliflozin benefit across clinically relevant patient subgroups for first and total HF hospitalizations. The need for new use of diuretics, renin-angiotensin modulators, or mineralocorticoid receptor antagonists after discharge was less in patients randomized to empagliflozin versus placebo (all P<0.05). CONCLUSIONS: Empagliflozin reduced the risk of HF in patients with left ventricular dysfunction or congestion after acute myocardial infarction. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04509674.