Dr Javed Butler Highlights Goals, Baseline Patient Characteristics in EMPACT-MI Trial

Javed Butler, MD, MPH, MBA, professor of medicine at University of Mississippi, president of the Baylor Scott & White Research Institute, explains the goals and patient population included in the EMPACT-MI trial.

Presented at the European Society of Cardiology (ESC) Congress 2023, EMPACT-MI is testing the safety and benefit of empagliflozin to reduce heart failure hospitalization or all-cause mortality in patients post myocardial infarction (MI).

Transcript

Can you give our audience an overview of your presentation on the EMPACT-MI trial?

There has been really no therapy that has shown risk reduction in post-MI heart failure development. We do know that once you develop heart failure, your 5-year mortality risk equals or exceeds about 50%, so anything to prevent heart failure is really important and myocardial infarction is one of the biggest risk factors. The data would suggest—epidemiologic data—that a quarter to a third of the patients post-MI develop heart failure, so prevention of heart failure is really, really important.

SGLT2 inhibitors have been shown to prevent heart failure in patients with CKD [chronic kidney disease] and diabetes, and MI patients are sort of an enriched population, but (A) we need to prove it, but (B) there are safety concerns also. The post-MI patients get procedures, an [intravenous] contrast, a new RAAS [renin-angiotensin-aldosterone system] inhibitor, a new MRA [mineralocorticoid receptor antagonist], and now SGLT2 inhibitor, so we need to see what the safety and what the benefit profile is.

That was being tested in the EMPACT-MI trial, a large trial, 6000 patients, about three-fourths STEMI [ST-elevation MI patients] and about one-fourth non-STEMI patients enriched for heart failure. So either new onset [MI], drop in EF [ejection fraction], or signs or symptoms of congestion. People with history of heart failure [prior to MI] were excluded. The trial has completed enrollment, is in the follow-up phase, and anxiously awaiting results and we'll get the results hopefully pretty soon in the next few months.

This transcript has been lightly edited for clarity.