Left Ventricular Function, Congestion, and Effect of Empagliflozin on Heart Failure Risk After Myocardial Infarction

Jacob A. Udell, Mark C. Petrie, W. Schuyler Jones, Stefan D. Anker, Josephine Harrington, Michaela Mattheus, Svenja Seide, Offer Amir, M. Cecilia Bahit, Johann Bauersachs, Antoni Bayes-Genis, Yundai Chen, Vijay K. Chopra, Gemma Figtree, Junbo Ge, Shaun G. Goodman, Nina Gotcheva, Shinya Goto, Tomasz Gasior, Waheed JamalJames L. Januzzi, Myung Ho Jeong, Yuri Lopatin, Renato D. Lopes, Béla Merkely, Monica Martinez-Traba, Puja B. Parikh, Alexander Parkhomenko, Piotr Ponikowski, Xavier Rossello, Morten Schou, Dragan Simic, Philippe Gabriel Steg, Joanna Szachniewicz, Peter van der Meer, Dragos Vinereanu, Shelley Zieroth, Martina Brueckmann, Mikhail Sumin, Deepak L. Bhatt, Adrian F. Hernandez, Javed Butler

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Empagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI). Objectives: This study sought to evaluate the association of left ventricular ejection fraction (LVEF), congestion, or both, with outcomes and the impact of empagliflozin in reducing HF risk post-AMI. Methods: In the EMPACT-MI (Trial to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction) trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF<45%, congestion, or both, to empagliflozin (10 mg daily) or placebo and were followed up for a median of 17.9 months. Results: Among 6,522 patients, the mean baseline LVEF was 41 ± 9%; 2,648 patients (40.6%) presented with LVEF <45% alone, 1,483 (22.7%) presented with congestion alone, and 2,181 (33.4%) presented with both. Among patients in the placebo arm of the trial, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause death or HF hospitalization (HR: 1.49; 95% CI: 1.31-1.69; P < 0.0001), first HF hospitalization (HR: 1.64; 95% CI: 1.37-1.96; P < 0.0001), and total HF hospitalizations (rate ratio [RR]: 1.89; 95% CI: 1.51-2.36; P < 0.0001). The presence of congestion was also associated with a significantly higher risk for each of these outcomes (HR: 1.52, 1.94, and RR: 2.03, respectively). Empagliflozin reduced the risk for first (HR: 0.77; 95% CI: 0.60-0.98) and total (RR: 0.67; 95% CI: 0.50-0.89) HF hospitalizations, irrespective of LVEF or congestion, or both. The safety profile of empagliflozin was consistent across baseline LVEF and irrespective of congestion status. Conclusions: In patients with AMI, the severity of left ventricular dysfunction and the presence of congestion was associated with worse outcomes. Empagliflozin reduced first and total HF hospitalizations across the range of LVEF with and without congestion.

Original languageEnglish
Pages (from-to)2233-2246
Number of pages14
JournalJournal of the American College of Cardiology
Issue number23
Early online date6 Apr 2024
StatePublished - 11 Jun 2024
Externally publishedYes

Bibliographical note

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  • acute myocardial infarction
  • congestion
  • empagliflozin
  • heart failure
  • left ventricular dysfunction


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