More than a 5 years ago the EPHESUS trial found that eplerenone (administered orally 25 to 50 mg a day) cut mortality significantly in 30 days post-randomization in patients with acute myocardial infarction (MI). Eplerenone had been known to reduce mortality in patients with heart failure (HF) or diabetes when begun early after myocardial infarction. All international guidelines have therefore accorded it a Class I indication. Eplerenone’s benefits were greatest when given early (3 to 7 days) post- myocardial infarction and are independent of standard care such as reperfusion, angiotensin converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, or diuretics. Crucially, eplerenone has been found to reduce mortality by lowering sudden cardiac death and therefore would be an important component in immediate post-MI treatment, when automatic implantable carioverter-defibrillators are not advised.
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