The Pharmaceutical Journal
Vol 275 No 7363 p218
20 August 2005

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Give eplerenone early after acute myocardial infarction

In the first month after myocardial infarction early treatment with eplerenone (Inspra) can reduce the risk of death by 31 per cent compared with placebo, research shows.

In a trial of 6,632 patients with acute MI, left ventricular systolic dysfunction and signs of heart failure, patients were treated with standard therapy and assigned to one of two groups.

There were 107 deaths (3.2 per cent) among patients treated with eplerenone (25mg daily) alongside standard therapy for 30 days. This compared with 153 deaths (4.6 per cent) among patients given placebo and represents a risk reduction of 31 per cent (95 per cent confidence interval, 0.54 to 0.89; P=0.004).

“It would seem prudent to initiate eplerenone in hospital following haemodynamic stabilisation after acute MI and to continue eplerenone in addition to an angiotensin converting enzyme inhibitor or an angiotensin-receptor blocker and a beta-blocker over the long term,” the researchers conclude (Journal of the American College of Cardiology 2005;46:425).