The following is a summary of “Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction,” published in the June 2024 issue of Cardiology by Udell et al.
Empagliflozin reduces the likelihood of hospitalizations for heart failure (HF) if started within 14 days of acute myocardial infarction (AMI) but does not impact overall mortality rates.
Researchers conducted a prospective study evaluating the impact of left ventricular ejection fraction (LVEF), congestion, or a combination of both on outcomes and the efficacy of empagliflozin in decreasing HF risk following AMI.
They conducted 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 with reduced LVEF<45%, congestion, or both were randomized within 14 days of AMI to receive either empagliflozin (10 mg daily) or a placebo. Patients were monitored for a median duration of 17.9 months.
The results showed 6,522 patients, baseline LVEF averaged 41± 9%; 2,648 patients (40.6%) presented with LVEF <45% alone, 1,483 (22.7%) had congestion alone, and 2,181 (33.4%) had both. In the placebo group, every 10-point LVEF drop increased risks of death/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). Empagliflozin was reduced first (HR: 0.77; 95% CI: 0.60-0.98), and total HF hospitalizations (RR: 0.67; 95% CI: 0.50-0.89) regardless of LVEF or congestion presence. The safety profile of empagliflozin was consistent.
Investigators concluded that in patients with AMI, worse left ventricular function and congestion led to poorer outcomes. Empagliflozin reduced first and total HF hospitalizations, regardless of LVEF or congestion.
Source: jacc.org/doi/10.1016/j.jacc.2024.03.405
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