AIMS: To test the hypothesis that an earlier post-acute myocardial infarction (AMI) eplerenone initiation in patients with left ventricular systolic dysfunction (LVSD) and heart failure (HF) is associated with better long-term outcomes. METHODS AND RESULTS: The 6632 patients of the EPHESUS study were randomized from day 3 to 14 after the index AMI (median = 7 days), of these 3319 were assigned to eplerenone. We analysed the differential effects of time-to-eplerenone initiation vs. placebo, based on the median time to initiation of treatment (<7 days-'earlier', > or =7days-'later'). Effects on outcomes were evaluated over a mean 16-month follow-up, using Cox proportional hazards regression analysis. The earlier eplerenone initiation (<7 days) reduced the risk of all-cause mortality by 31% (P = 0.001) when compared with the 'earlier' placebo' and also reduced the risks of cardiovascular (CV) hospitalization/CV mortality by 24% (P < 0.0001) and sudden cardiac death (SCD) by 34% (P < 0.0001). In contrast, later eplerenone initiation (> or =7 days) had no significant effect on outcomes. Interactions between time-to-randomization and treatment were significant. These associations remained substantially unchanged after risk adjustment in multivariable models. CONCLUSION: An earlier eplerenone administration (3-7days) post-AMI improved outcomes in patients with LVSD and HF. This benefit was not observed when eplerenone was initiated later (> or =7days).
AIMS: To test the hypothesis that an earlier post-acute myocardial infarction (AMI) eplerenone initiation in patients with left ventricular systolic dysfunction (LVSD) and heart failure (HF) is associated with better long-term outcomes. METHODS AND RESULTS: The 6632 patients of the EPHESUS study were randomized from day 3 to 14 after the index AMI (median = 7 days), of these 3319 were assigned to eplerenone. We analysed the differential effects of time-to-eplerenone initiation vs. placebo, based on the median time to initiation of treatment (<7 days-'earlier', > or =7days-'later'). Effects on outcomes were evaluated over a mean 16-month follow-up, using Cox proportional hazards regression analysis. The earlier eplerenone initiation (<7 days) reduced the risk of all-cause mortality by 31% (P = 0.001) when compared with the 'earlier' placebo' and also reduced the risks of cardiovascular (CV) hospitalization/CV mortality by 24% (P < 0.0001) and sudden cardiac death (SCD) by 34% (P < 0.0001). In contrast, later eplerenone initiation (> or =7 days) had no significant effect on outcomes. Interactions between time-to-randomization and treatment were significant. These associations remained substantially unchanged after risk adjustment in multivariable models. CONCLUSION: An earlier eplerenone administration (3-7days) post-AMI improved outcomes in patients with LVSD and HF. This benefit was not observed when eplerenone was initiated later (> or =7days).
Authors: M Hayashi; T Tsutamoto; A Wada; K Maeda; N Mabuchi; T Tsutsui; T Matsui; M Fujii; T Matsumoto; T Yamamoto; H Horie; M Ohnishi; M Kinoshita Journal: J Am Coll Cardiol Date: 2001-11-01 Impact factor: 24.094
Authors: B Pitt; G Williams; W Remme; F Martinez; J Lopez-Sendon; F Zannad; J Neaton; B Roniker; S Hurley; D Burns; R Bittman; J Kleiman Journal: Cardiovasc Drugs Ther Date: 2001-01 Impact factor: 3.727
Authors: Eric J Velazquez; Gary S Francis; Paul W Armstrong; Phillip E Aylward; Rafael Diaz; Christopher M O'Connor; Harvey D White; Marc Henis; Lois M Rittenhouse; Rakhi Kilaru; Wiek van Gilst; Georg Ertl; Aldo P Maggioni; Jiri Spac; W Douglas Weaver; Jean-Lucien Rouleau; John J V McMurray; Marc A Pfeffer; Robert M Califf Journal: Eur Heart J Date: 2004-11 Impact factor: 29.983
Authors: Daniela Fraccarollo; Paolo Galuppo; Jan-Thorben Sieweke; L Christian Napp; Paul Grobbecker; Johann Bauersachs Journal: ESC Heart Fail Date: 2015-07-28
Authors: Jakub Gawrys; Karolina Gawrys; Ewa Szahidewicz-Krupska; Arkadiusz Derkacz; Jakub Mochol; Adrian Doroszko Journal: Biomed Res Int Date: 2018-10-02 Impact factor: 3.411