Empagliflozin does not affect cardiac remodeling after acute MI

This summary is based on the presentation of Jaclyn Carberry, MD (Glasgow, UK) at the ESC Congress 2024 - Empagliflozin to prevent worsening of left ventricular volumes and systolic function after myocardial infarction.

Introduction and methods

Patients who have a reduced LVEF after an acute MI are at risk of progressive adverse cardiac remodeling, which can lead to the development of HF. Early treatment with empagliflozin after MI may delay or prevent progressive adverse remodeling in patients with increased risk of HF.

The EMPRESS-MI (EMpagliflozin to PREvent worSening of left ventricular volumes and Systolic function after Myocardial Infarction) trial was a multicenter, double-blind, placebo-controlled, phase 3 RCT in which 105 patients with acute type 1 MI and LVEF <45% (as assessed by cardiac MRI) were included. Participants were randomized ≥12 h and ≤14 days following hospital admission for MI to empagliflozin 10 mg once daily or placebo, in addition to standard of care.

The primary endpoints was change in LV end-systolic volume index, as assessed by cardiac MRI, from baseline to 24 weeks. Secondary endpoints include changes from baseline to 24 weeks in LV end-diastolic volume index, LVEF, left atrial volume index, LV mass index, NT-proBNP levels, hs-TnI levels, and infarct size assessed by MRI.

Main results

• At 24 weeks, the mean ± SD change in the primary endpoint of LV end-systolic volume index from baseline was –8.3 ± 13.5 mL/m² in patients treated with empagliflozin and –7.8 ± 16.3 mL/m² in patients receiving placebo (difference: 0.3 mL/m²; 95%CI: –5.2 to 5.8; P=0.92).
• The mean ± SD LVEF increased in both empagliflozin-treated patients (9.4 ± 7.5%) and placebo-treated patients (8.5 ± 7.4%), but there was no significant difference between the groups (0.0%; 95%CI: –2.9 to 3.0; P=0.98).
• There were also no significant differences between the empagliflozin and placebo groups in any of the other secondary endpoints (all P>0.05).

Conclusion

In the EMPRESS-MI trial among high-risk patients with LV systolic dysfunction after acute MI, there was little evidence of progressive adverse cardiac remodeling over 24 weeks. Empagliflozin had no effect on changes in LV volumes and function or other measures of cardiac remodeling compared with placebo.

- Our reporting is based on the information provided at the ESC Congress 2024 -