Key result
Finerenone improves 60-day LVEF by an absolute ~2.5% over placebo after anterior STEMI.
Why the study?
Cardiac remodeling after anterior STEMI can occur even after successful reperfusion, leading to declined LV function, cardiac output, and exercise capacity. Studies evaluating whether finerenone attenuates post-infarction cardiac remodeling and improves exercise capacity in post-MI patients remain very limited.
Does finerenone 10 mg daily for 60 days improve left ventricular function, cardiac output, and exercise capacity in patients with anterior STEMI and LVEF >40% following successful primary PCI?
RCT (n=52)
Double-blind
Randomized
Does finerenone 10 mg daily for 60 days improve left ventricular function, cardiac output, and exercise capacity in patients with anterior STEMI and LVEF >40% following successful primary PCI?
In patients with anterior STEMI and LVEF >40% treated with primary PCI, 60 days of finerenone 10 mg daily significantly improved echocardiographic parameters of LV function (LVEF and GLS) compared to placebo, though it did not significantly alter cardiac output or exercise capacity.
Answers are grounded in this paper and cite their sources.
Finerenone after anterior STEMI with LVEF >40% is hypothesis-generating and should not yet change practice; leaves open whether early remodeling improvements reduce hard clinical events.
Background Cardiac remodeling post-myocardial infarction (MI) can occur even after successful coronary reperfusion, particularly in anterior ST-elevation myocardial infarction (STEMI). This remodeling process may lead to a decline in left ventricular (LV) fuction, cardiac output and exercise capacity thereby increasing the risk of major adverse cardiovascular events. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, exerts anti-inflammatory and antifibrotic effects that may attenuate post-infarction remodeling. Studies evaluating the effects of finerenone on cardiac remodeling and exercise capacity in post MI patients are still very limited. Purpose to evaluate the effect of Finerenone on LV function, cardiac output (CO) and exercise capacity in patients with anterior STEMI who underwent primary percutaneous coronary intervention (PPCI). Methods This was a double-blind randomized controlled clinical trial involving patients with anterior STEMI and a left ventricular ejection fraction (LVEF) >40% who successfully underwent primary PCI. Participants received either Finerenone 10 mg daily (n = 27) or placebo (n = 25) for 60 days, in addition to standard medical therapy. LVEF and global longitudinal strain (GLS) as parameters of LV function and cardiac output was measured using echocardiography at predischarge and after 60 days of treatment. Exercise capacity was assessed by cardiopulmonary exercise testing (CPET). Results Baseline clinical characteristics were comparable between the two groups. After 60 days follow up, improvement of LVEF and GLS was greater in finerenone group compared with control group (Δ LVEF pre→post 4,62 ± 3,11% vs 2,16 ± 3,23%; p = 0.007; Δ GLS pre→post -3,22 ± 2,68% vs -1,60 ± 2,29; p = 0.024). The mean change in CO (Δ pre→post) was greater in the Finerenone group (+0.32 ± 1.03 vs −0.07 ± 1.17; p = 0.203), though not statistically significant. Exercise capacity parameters were also higher in the Finerenone group but did not reach statistical significance (peak VO2 23.6 ± 3.8 vs 21.6 ± 3.9 mL·kg−1·min−1, p = 0.084; oxygen pulse 12.5 ± 2.3 vs 11.6 ± 2.7 mL/beat, p = 0.216; METs 6.66 ± 1.24 vs 6.17 ± 1.10, p = 0.139). No clinically relevant adverse events related to Finerenone 10 mg were observed during the follow up. Conclusions Administration of Finerenone 10 mg for 60 days improve of LV function, while did not result in significant differences in cardiac output or exercise capacity compared with placebo in patients with anterior STEMI following primary PCI.Picture and diagram
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Sungkar et al. (2026) conducted an RCT in Anterior ST-elevation myocardial infarction (STEMI) (n=52). Finerenone vs. Placebo was evaluated on Change in left ventricular ejection fraction (Δ LVEF pre→post) (p=0.007). Finerenone 10 mg daily significantly improved LVEF (Δ +4.62% vs +2.16%; p=0.007) and GLS (p=0.024) at 60 days vs placebo after anterior STEMI, without significantly altering exercise capacity.
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