EMPACT-MI Results: Empagliflozin After Acute Myocardial Infarction
Apr 9, 2024
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Cardiologists Javed Butler and Sun Moon Kim discuss EMPACT-MI trial results on heart failure risk post-myocardial infarction. They explore misconceptions on EF percentages, diuretics, and benefits of SGLT2 inhibitors. Real-world evidence shapes future treatment strategies.
EMPACT-MI trial showed 23% reduction in heart failure hospitalizations.
Consider early SGLT2 inhibitor initiation in post-MI patients for heart failure risk reduction.
Deep dives
Impact Trial Rationale
The rationale behind the Impact trial design centered on addressing the persistent high risk of heart failure in patients post acute myocardial infarction (MI). The trial aimed to test the impact of M-Buckla Flowsen in reducing the risk of heart failure in these patients by drawing on previous positive results in high-risk populations like those with diabetes, chronic kidney disease, and known heart failure.
Results and Endpoint Focus
The Impact trial included patients with post-MI congestion or a drop in left ventricular ejection fraction within 14 days, emphasizing a streamlined pragmatic approach to avoid additional burden on patients and sites. While the trial did not show a statistical significance in all-cause mortality reduction, it demonstrated a 23% relative risk reduction in heart failure hospitalizations and a 33% risk reduction in total heart failure burden, indicating a significant impact on heart failure outcomes.
Long-term Implications and Application
Despite the lack of mortality benefit in the short term, the trial highlighted a significant reduction in heart failure risks, prompting considerations for long-term follow-up to assess the sustained impact on cardiovascular outcomes. The results suggest a clinical strategy of early initiation of SGLT2 inhibitors in post-MI patients with indications like heart failure, diabetes, or chronic kidney disease, while vigilance is advised for low-risk individuals post-revascularization with positive recovery.
Patients with acute myocardial infarction are at a high risk of heart failure and death. Despite advances in care and reduction in the rate of recurrent myocardial infarctions, the risk for heart failure continues to be unacceptably high. No intervention in 2 decades has been shown to improve this risk.
In this interview, Javed Butler, MD, MPH, MBA, and Sun Moon Kim, MD, FACC, discuss the results of the EMPACT-MI trial.
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