Empagliflozin proves beneficial in acute myocardial infarction: EMMY trial

AUSTRIA: Acute myocardial infarction (MI) patients who receive the SGLT2 inhibitor empagliflozin (Jardiance) early after the MI have improved markers of cardiac structure and function and natriuretic peptide levels, according to recent randomized trial findings published in the European Heart Journal.

In both the recently published DELIVER trial and the EMPEROR-Preserved trial from the previous year, SGLT2 inhibitors have demonstrated benefits in heart failure patients (HF) throughout the spectrum of left ventricular function, decreasing the risk for hospital treatment and cardiac mortality in low ejection fraction (EF). In addition, SGLT2 inhibitors reduce the risk of HF in high-risk populations such as people with type 2 diabetes and those with chronic renal disease. There aren't enough trials, though, looking at how this drug class affects people who have recently suffered an acute myocardial infarction.

"The question of whether an SLGT2 inhibitor medication would be advantageous if begun soon after an acute myocardial infarction was naturally relevant given that advantages show up within weeks, independent of the trial, and since MI is a key contributor to incident heart failure. But these data are insufficient", the authors said.

476 patients who had undergone an acute MI and were within 72 hours of a percutaneous coronary intervention were randomly assigned to receive empagliflozin 10 mg once day or a matching placebo in the double-blind EMMY study, which was conducted at 11 Austrian locations from May 2017 to May 2022. Along with antiplatelet medications (100%), statins (97%), and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (96%), this was added to the post-MI therapy recommended by guidelines. The N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) change during 26 weeks was the main result. NT-proBNP was 1,294 (757-2,246) pg/ml at the baseline median (interquartile range). Echocardiographic parameter alterations were among the secondary outcomes.

Key findings of the trial:

• After correcting for baseline NT-proBNP, sex, and diabetes condition, NT-proBNP decline was considerably larger in the empagliflozin group compared to the placebo group, being 15% lower.
• The difference between the empagliflozin group and the placebo group in terms of absolute left ventricular ejection fraction improvement was considerably greater (1.5%), mean E/e' reduction was more (6.8%), and left ventricular end-systolic and end-diastolic volumes were lower by 7.5 ml and 9.7 ml respectively.
• Seven people were admitted to the hospital with heart failure (three in the empagliflozin group)

In individuals who had recently experienced a myocardial infarction, empagliflozin was linked to a much larger NT-proBNP reduction over the course of 26 weeks, as well as a markedly better set of structural and functional echocardiographic measures, concluded the authors.

REFERENCE

Dirk von Lewinski, Ewald Kolesnik, Norbert J Tripolt, Peter N Pferschy, Martin Benedikt, Markus Wallner, Hannes Alber, Rudolf Berger, Michael Lichtenauer, Christoph H Saely, Deddo Moertl, Pia Auersperg, Christian Reiter, Thomas Rieder, Jolanta M Siller-Matula, Gloria M Gager, Matthias Hasun, Franz Weidinger, Thomas R Pieber, Peter M Zechner, Markus Herrmann, Andreas Zirlik, Rury R Holman, Abderrahim Oulhaj, Harald Sourij, on behalf of the EMMY Investigators, Empagliflozin in acute Myocardial Infarction: the EMMY trial, European Heart Journal, 2022;, ehac494, https://doi.org/10.1093/eurheartj/ehac494