Background: Empagliflozin reduces the risk of heart failure events in patients with type 2 diabetes at high cardiovascular risk, chronic kidney disease, and in those with prevalent heart failure irrespective of ejection fraction. While EMPACT-MI showed empagliflozin does not reduce the risk of the composite of hospitalization of heart failure and all-cause mortality, the impact of empagliflozin on first and recurrent heart failure events in patients after myocardial infarction is unknown.Methods: EMPACT-MI was a double-blind, randomized, placebo-controlled, event-driven trial that randomized 6522 patients hospitalized for acute myocardial infarction at risk for heart failure based on newly developed left ventricular ejection fraction of <45% and/or signs or symptoms of congestion to receive empagliflozin 10 mg daily or placebo within 14 days of admission. In prespecified secondary analyses, treatment groups were analyzed for heart failure outcomes.Results: Over a median of follow-up of 17.9 months, the risk for first heart failure hospitalization and total heart failure hospitalizations was significantly lower in the empagliflozin compared with the placebo group (118 (3.6%) vs. 153 (4.7%) patients with events, HR 0.77 [95% CI 0.60, 0.98], P=0.031 for first heart failure hospitalization and 148 vs. 207 events, RR 0.67 [95% CI 0.51, 0.89], P=0.006 for total heart failure hospitalizations). Subgroup analysis showed consistency of empagliflozin benefit across clinically relevant patient subgroups for first and total heart failure hospitalizations. Post-discharge need for new use of diuretics, renin-angiotensin modulators, and mineralocorticoid receptor antagonists were less in patients randomized to empagliflozin than placebo (all p<0.05).Conclusions: In patients after acute myocardial infarction with left ventricular dysfunction or congestion, empagliflozin reduced the risk of heart failure.

中文翻译：

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恩格列净对急性心肌梗死后心力衰竭结局的影响：来自 EMPACT-MI 试验的见解

背景：恩格列净可降低心血管风险高的 2 型糖尿病患者、慢性肾病患者以及患有常见心力衰竭的患者（无论射血分数如何）发生心力衰竭事件的风险。虽然 EMPACT-MI 显示恩格列净不会降低心力衰竭住院和全因死亡率的复合风险，但恩格列净对心肌梗死后患者首次和复发心力衰竭事件的影响尚不清楚。方法：EMPACT-MI一项双盲、随机、安慰剂对照、事件驱动试验，根据新出现的左心室射血分数 <45% 和/或充血体征或症状，对 6522 名因急性心肌梗塞住院且有心力衰竭风险的患者进行随机分组入院 14 天内每天服用恩格列净 10 mg 或安慰剂。在预先指定的二次分析中，对治疗组的心力衰竭结局进行了分析。结果：在中位随访时间 17.9 个月内，恩格列净组首次心力衰竭住院和完全心力衰竭住院的风险显着低于安慰剂组（118 例 (3.6%) 对比 153 例 (4.7%) 患者发生事件，HR 0.77 [95% CI 0.60, 0.98]，首次心力衰竭住院 P=0.031；148 例对比 207 例事件，RR 0.67 [95% CI 0.51 ，0.89]，总心力衰竭住院治疗 P=0.006）。亚组分析显示，恩格列净在首次和完全心力衰竭住院治疗的临床相关患者亚组中的获益具有一致性。随机接受恩格列净治疗的患者出院后需要新使用利尿剂、肾素血管紧张素调节剂和盐皮质激素受体拮抗剂的次数少于安慰剂组（均 p<0.05）。 结论：在急性心肌梗死后伴有左心室功能障碍或充血的患者中，恩格列净可降低心力衰竭的风险。