Eplerenone Doesn’t Lead to Hyperkalemia in AMI Patients with Heart Failure

In acute myocardial infarction (AMI) survivors with heart failure and left ventricular systolic dysfunction, selective aldosterone blockade with eplerenone reduces mortality while avoiding hyperkalemia, according to a trial reported in Circulation.

The “Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study” (EPHESUS) included 6632 post-AMI patients with congestive heart failure and a left ventricular ejection fraction of 40 percent or less. Patients received eplerenone, 25 to 50 mg/dL, or placebo in addition to standard therapy.

The eplerenone group had a 4.4 percent absolute increase in risk of hyperkalemia (more than 5.5 mEq/L) and a 1.6 percent increase in more marked hyperkalemia (6.0 mEq/L or greater). The incidence of hypokalemia (less than 3.5 mEq/L) was decreased by 4.7 percent.

The EPHESUS investigators hope their report will alleviate fears that eplerenone may induce hyperkalemia in post-AMI patients with heart failure. They recommend adding eplerenone to standard treatment for post-AMI patients who also have heart failure,” as called for in current U.S. and European guidelines [Pitt B, Bakris G, Ruilope LM, et al, DiCarlo L and Mukherjee R, on behalf of the EPHESUS Investigators: Serum potassium and clinical outcomes in the eplerenone post–acute myocardial infarction heart failure efficacy and survival study (EPHESUS). Circulation, 2008; 118:1643–1650].