Early eplerenone treatment in patients with acute ST-elevation myocardial infarction without heart failure: The Randomized Double-Blind Reminder Study

Addition of eplerenone during the acute phase of STEMI in 1012 patients without heart failure, reduced the primary endpoint vs placebo (18.2% vs 29.4%; 95% CI, 0.45–0.76; p<0.0001) mainly because of lower BNP/NT-proBNP levels (adjusted HR, 0.60; 95% CI, 0.45–0.79; P < 0.0003).

A related editorial notes that despite a primary composite endpoint that included several clinical events (cardiovascular death, heart failure, or sustained ventricular arrhythmia), the REMINDER study should be considered a ‘proof-of-concept’ trial, driven by the ‘surrogate’ endpoint of elevated levels of natriuretic peptides, which accounted for 87% of the primary composite endpoint events.

A larger, adequately powered study with longer follow up is required before a strategy of early mineralocorticoid receptor antagonist administration could be recommended for the broader STEMI population.