Eplerenone added to standard therapy in post-MI heart failure patients caused a 1.6% absolute increase in severe hyperkalemia (K+ ≥6.0 mEq/L) but did not impact its all-cause mortality benefit.
RCT (n=6,632)
Does eplerenone increase the risk of severe hyperkalemia and affect mortality benefit in post-MI patients with heart failure and LVEF ≤40%?
Eplerenone improves outcomes in post-MI heart failure patients without an excessive risk of severe hyperkalemia when periodic potassium monitoring is used.
Effect estimate: 4.4% absolute increase
BACKGROUND: Aldosterone blockade is recommended for patients with congestive heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction; however, the perceived risk of hyperkalemia may limit implementation of this therapeutic approach. This subanalysis examined the relationship between eplerenone, serum potassium (K(+)), and clinical outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). METHODS AND RESULTS: Hospitalized patients with congestive heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction (left ventricular ejection fraction 5.0 mEq/L or serum creatinine was >2.5 mg/dL. In patients receiving standard therapy, the addition of eplerenone resulted in a 4.4% absolute increase in the incidence of K(+) >5.5 mEq/L, a 1.6% increase of K(+) > or =6.0 mEq/L, and a 4.7% absolute decrease in hypokalemia (K(+) or =6.0 mEq/L) were identified: potassium (K(+) greater than the median; 4.3 mEq/L), estimated glomerular filtration rate ( or =6.0 mEq/L) when periodic monitoring of serum K(+) is instituted.
Pitt et al. (Tue,) conducted a rct in Congestive heart failure after acute myocardial infarction with left ventricular systolic dysfunction (n=6,632). Eplerenone vs. Placebo was evaluated on Incidence of hyperkalemia (K+ >5.5 mEq/L) (4.4% absolute increase). Eplerenone added to standard therapy in post-MI heart failure patients caused a 1.6% absolute increase in severe hyperkalemia (K+ ≥6.0 mEq/L) but did not impact its all-cause mortality benefit.