Article,
Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction
Contributors
Udell, Jacob Allan
0000-0001-7402-9584
(Corresponding author)
[1]
[2]
Petrie, Mark Colquhoun
0000-0002-6333-9496
[3]
Jones, William Schuyler
0000-0002-7288-9596
[4]
[5]
Mattheus, Michaela
0000-0002-8611-6236
[7]
Bahit, Maria Cecilia
0000-0001-6179-4076
[10]
Bayes-Genis, Antoni
0000-0002-3044-197X
[12]
[13]
Chopra, Vijay Kumar
0000-0001-9512-1718
[15]
Figtree, Gemma Alexandra
0000-0002-5080-6083
[16]
Ge, Jun-Bo
0000-0002-9360-7332
[17]
[18]
Goodman, Shaun Geoffrey
0000-0001-8068-2440
[2]
[19]
[20]
Gasior, Tomasz
0000-0001-5088-4164
[7]
[23]
Januzzi, James Louis
0000-0002-8338-1798
[24]
[25]
[26]
Jeong, Myung H O
0000-0003-2424-810X
[27]
Parikh, Puja B
0000-0002-0048-2789
[30]
Rossello, Xavier
0000-0001-6783-8463
[33]
Steg, Philippe Gabriel
0000-0001-6896-2941
[36]
Brueckmann, Martina
0000-0003-1215-0746
[7]
[42]
Sumin, Mikhail
0000-0002-3827-5793
[7]
Bhatt, Deepak L
0000-0002-1278-6245
[43]
Affiliations
- [1] Women's College Hospital [NORA names: Canada; America, North; OECD];
- [2] University of Toronto [NORA names: Canada; America, North; OECD];
- [3] University of Glasgow [NORA names: United Kingdom; Europe, Non-EU; OECD];
- [4] Duke University [NORA names: United States; America, North; OECD];
- [5] Duke University Hospital [NORA names: United States; America, North; OECD];
(... more)
Abstract
BACKGROUND: Empagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI). OBJECTIVES: This study sought to evaluate the association of left ventricular ejection fraction (LVEF), congestion, or both, with outcomes and the impact of empagliflozin in reducing HF risk post-AMI. METHODS: In the EMPACT-MI (Trial to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction) trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF<45%, congestion, or both, to empagliflozin (10 mg daily) or placebo and were followed up for a median of 17.9 months. RESULTS: Among 6,522 patients, the mean baseline LVEF was 41 ± 9%; 2,648 patients (40.6%) presented with LVEF <45% alone, 1,483 (22.7%) presented with congestion alone, and 2,181 (33.4%) presented with both. Among patients in the placebo arm of the trial, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause death or HF hospitalization (HR: 1.49; 95% CI: 1.31-1.69; P < 0.0001), first HF hospitalization (HR: 1.64; 95% CI: 1.37-1.96; P < 0.0001), and total HF hospitalizations (rate ratio [RR]: 1.89; 95% CI: 1.51-2.36; P < 0.0001). The presence of congestion was also associated with a significantly higher risk for each of these outcomes (HR: 1.52, 1.94, and RR: 2.03, respectively). Empagliflozin reduced the risk for first (HR: 0.77; 95% CI: 0.60-0.98) and total (RR: 0.67; 95% CI: 0.50-0.89) HF hospitalizations, irrespective of LVEF or congestion, or both. The safety profile of empagliflozin was consistent across baseline LVEF and irrespective of congestion status. CONCLUSIONS: In patients with AMI, the severity of left ventricular dysfunction and the presence of congestion was associated with worse outcomes. Empagliflozin reduced first and total HF hospitalizations across the range of LVEF with and without congestion. (Trial to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction [EMPACT-MI]; NCT04509674).
