Empagliflozin in acute myocardial infarction: the EMMY trial

  • Dirk von Lewinski
    Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Ewald Kolesnik
    Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Norbert J Tripolt
    Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Peter N Pferschy
    Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Martin Benedikt
    Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Markus Wallner
    Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Hannes Alber
    Department of Cardiology, Public Hospital Klagenfurt am Woerthersee , Klagenfurt am Woerthersee , Austria
  • Rudolf Berger
    Department of Internal Medicine, Brothers of Saint John of God Eisenstadt , Eisenstadt , Austria
  • Michael Lichtenauer
    Department of Internal Medicine II, Division of Cardiology and Internal Intensive Care Medicine, Paracelsus Medical Private University Salzburg , Salzburg , Austria
  • Christoph H Saely
    Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT) , Feldkirch , Austria
  • Deddo Moertl
    Karl Landsteiner University of Health Sciences , 3050 Krems , Austria
  • Pia Auersperg
    Karl Landsteiner University of Health Sciences , 3050 Krems , Austria
  • Christian Reiter
    Department of Cardiology and Intensive Care Medicine, Kepler University Hospital Linz , Linz , Austria
  • Thomas Rieder
    Department of Medicine, Kardinal Schwarzenberg Hospital Schwarzach , Schwarzach , Austria
  • Jolanta M Siller-Matula
    Department of Cardiology, Medical University of Vienna , Vienna , Austria
  • Gloria M Gager
    Department of Cardiology, Medical University of Vienna , Vienna , Austria
  • Matthias Hasun
    2nd Medical Department with Cardiology and Intensive Care Medicine, Hospital Landstrasse , Vienna , Austria
  • Franz Weidinger
    2nd Medical Department with Cardiology and Intensive Care Medicine, Hospital Landstrasse , Vienna , Austria
  • Thomas R Pieber
    Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Peter M Zechner
    Department of Cardiology and Intensive Care Medicine, Hospital Graz South West, West Location , Graz , Austria
  • Markus Herrmann
    Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz , Graz , Austria
  • Andreas Zirlik
    Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria
  • Rury R Holman
    Radcliffe Department of Medicine, University of Oxford , Oxford , UK
  • Abderrahim Oulhaj
    Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University , Abu Dhabi , UAE
  • Harald Sourij
    Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz , Austria

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Aims</jats:title><jats:p>Sodium–glucose co-transporter 2 inhibition reduces the risk of hospitalization for heart failure and for death in patients with symptomatic heart failure. However, trials investigating the effects of this drug class in patients following acute myocardial infarction are lacking.</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>In this academic, multicentre, double-blind trial, patients (n = 476) with acute myocardial infarction accompanied by a large creatine kinase elevation (&gt;800 IU/L) were randomly assigned to empagliflozin 10 mg or matching placebo once daily within 72 h of percutaneous coronary intervention. The primary outcome was the N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) change over 26 weeks. Secondary outcomes included changes in echocardiographic parameters. Baseline median (interquartile range) NT-proBNP was 1294 (757–2246) pg/mL. NT-proBNP reduction was significantly greater in the empagliflozin group, compared with placebo, being 15% lower [95% confidence interval (CI) −4.4% to −23.6%] after adjusting for baseline NT-proBNP, sex, and diabetes status (P = 0.026). Absolute left-ventricular ejection fraction improvement was significantly greater (1.5%, 95% CI 0.2–2.9%, P = 0.029), mean E/e′ reduction was 6.8% (95% CI 1.3–11.3%, P = 0.015) greater, and left-ventricular end-systolic and end-diastolic volumes were lower by 7.5 mL (95% CI 3.4–11.5 mL, P = 0.0003) and 9.7 mL (95% CI 3.7–15.7 mL, P = 0.0015), respectively, in the empagliflozin group, compared with placebo. Seven patients were hospitalized for heart failure (three in the empagliflozin group). Other predefined serious adverse events were rare and did not differ significantly between groups.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>In patients with a recent myocardial infarction, empagliflozin was associated with a significantly greater NT-proBNP reduction over 26 weeks, accompanied by a significant improvement in echocardiographic functional and structural parameters.</jats:p></jats:sec><jats:sec><jats:title>ClinicalTrials.gov registration</jats:title><jats:p> NCT03087773.</jats:p></jats:sec>

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