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

被引：42

作者：

Hernandez, Adrian F. ^{[1
,2
]}

Udell, Jacob A. ^{[3
,4
]}

Jones, W. Schuyler ^{[1
,2
]}

Anker, Stefan D. ^{[5
]}

Petrie, Mark C. ^{[6
]}

Harrington, Josephine ^{[1
,2
]}

Mattheus, Michaela ^{[7
]}

Seide, Svenja ^{[7
]}

Zwiener, Isabella ^{[7
]}

Amir, Offer ^{[8
]}

Bahit, M. Cecilia ^{[9
]}

Bauersachs, Johann ^{[10
]}

Bayes-Genis, Antoni ^{[11
,12
]}

Chen, Yundai ^{[13
]}

Chopra, Vijay K. ^{[14
]}

Figtree, Gemma A. ^{[15
]}

Ge, Junbo ^{[16
]}

Goodman, Shaun G. ^{[17
,18
]}

Gotcheva, Nina ^{[19
]}

Goto, Shinya ^{[20
]}

Gasior, Tomasz ^{[21
,22
]}

Jamal, Waheed ^{[21
]}

Januzzi, James L. ^{[23
,24
]}

Jeong, Myung Ho ^{[25
]}

Lopatin, Yuri ^{[26
]}

Lopes, Renato D. ^{[1
,2
]}

Merkely, Bela ^{[27
]}

Parikh, Puja B. ^{[28
]}

Parkhomenko, Alexander ^{[29
]}

Ponikowski, Piotr ^{[30
]}

Rossello, Xavier ^{[31
]}

Schou, Morten ^{[32
]}

Simic, Dragan ^{[33
]}

Steg, Philippe Gabriel ^{[34
]}

Szachniewicz, Joanna ^{[35
]}

van der Meer, Peter ^{[36
]}

Vinereanu, Dragos ^{[37
]}

Zieroth, Shelley ^{[38
]}

Brueckmann, Martina ^{[21
,39
]}

Sumin, Mikhail ^{[21
]}

Bhatt, Deepak L. ^{[40
]}

Butler, Javed ^{[41
,42
]}

机构：

[1] Duke Univ, Div Cardiol, Dept Med, Durham, NC USA

[2] Duke Clin Res Inst, 300 W Morgan St, Durham, NC 27701 USA

[3] Univ Toronto, Toronto Gen Hosp, Womens Coll Hosp, Toronto, ON, Canada

[4] Univ Toronto, Toronto Gen Hosp, Peter Munk Cardiac Ctr, Toronto, ON, Canada

[5] Charite Univ Med Berlin, Berlin Inst Hlth Ctr Regenerat Therapies BCRT, Dept Cardiol CVK,German Heart Ctr Charite, German Ctr Cardiovasc Res DZHK,Partner Site B, Berlin, Germany

[6] Univ Glasgow, Sch Cardiovasc & Med Sci, British Heart Fdn Glasgow Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

[7] Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany

[8] Hebrew Univ Jerusalem, Inst Heart, Hadassah Med Ctr, Jerusalem, Israel

[9] Fdn INECO, INECO Neurociencias Orono, Rosario, Santa Fe, Argentina

[10] Hannover Med Sch, Dept Cardiol & Angiol, Hannover, Germany

[11] Hosp Badalona Germans Trias & Pujol, Inst Heart, Barcelona, Spain

[12] Univ Autnomoa Barcelona, Dept Med, Barcelona, Spain

[13] Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Med Ctr 1, Beijing, Peoples R China

[14] Max Super Special Hosp, Saket, New Delhi, India

[15] Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia

[16] Fudan Univ, Shanghai Inst Cardiovasc Dis, Zhongshan Hosp, Dept Cardiol,Natl Clin Res Ctr Intervent Med, Shanghai, Peoples R China

[17] Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada

[18] Univ Toronto, Dept Med, St Michaels Hosp, Div Cardiol,Unity Hlth Toronto, Toronto, ON, Canada

[19] MHAT Natl Cardiol Hosp EAD, Dept Cardiol, Sofia, Bulgaria

[20] Tokai Univ, Dept Med Cardiol, Sch Med, Isehara, Kanagawa, Japan

[21] Boehringer Ingelheim Int GmbH, Ingelheim, Germany

[22] WSB Univ, Coll Med, Fac Med, Dabrowa Gornicza, Poland

[23] Harvard Med Sch, Div Cardiol, Boston, MA USA

[24] Massachusetts Gen Hosp, Boston, MA USA

[25] Chonnam Natl Univ Hosp & Med Sch, Gwangju, South Korea

[26] Volgograd State Med Univ, Volgograd, Russia

[27] Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary

[28] SUNY Stony Brook, Div Cardiovasc Med, Dept Med, Stony Brook, NY USA

[29] AMS Ukraine, Ukrainian Inst Cardiol MD Strazhesko, Kyiv, Ukraine

[30] Wroclaw Med Univ, Inst Heart Dis, Wroclaw, Poland

[31] Univ Balear Islands, Hlth Res Inst Balear Islands, Hosp Univ Son Espases, Palma De Mallorca, Spain

[32] Herlev & Gentofte Univ Hosp, Dept Cardiol, Copenhagen, Denmark

[33] Univ Clin Ctr Belgrade, Dept Cardiovasc Dis, Belgrade, Serbia

[34] Univ Paris Cite, Hop Bichat, AP HP,U 1148, INSERM,FACT French Alliance Cardiovasc Trials, Paris, France

[35] Jan Mikulicz Radecki Univ Clin Hosp, Wroclaw, Poland

[36] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[37] Univ Med & Pharm Carol Davila, Univ & Emergency Hosp, Bucharest, Romania

[38] Univ Manitoba, Sect Cardiol, Max Rady Coll Med, Winnipeg, MB, Canada

[39] Heidelberg Univ, Fac Med Mannheim, Dept Med 1, Mannheim, Germany

[40] Icahn Sch Med Mt Sinai, Mt Sinai Fuster Heart Hosp, New York, NY USA

[41] Baylor Scott & White Res Inst, Dallas, TX USA

[42] Univ Mississippi, Dept Med, Jackson, MS USA

来源：

CIRCULATION | 2024年 / 149卷 / 21期

关键词：

heart failure; hospitalization; myocardial infarction;

D O I：

10.1161/CIRCULATIONAHA.124.069217

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1627 / 1638

页数：12

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