A 63-year-old man completed primary PCI for an anterior STEMI. Discharge echocardiography shows an ejection fraction of 33 percent with anterior wall hypokinesia. He is already on aspirin, ticagrelor, atorvastatin, metoprolol, ramipril, and euglycemic for newly detected diabetes. Which additional drug has been shown to reduce cardiovascular death and heart failure hospitalization in this setting?
- A Digoxin
- B Eplerenone ✓
- C Amiodarone
- D Furosemide
Correct answer: B. Eplerenone
Explanation
Mineralocorticoid receptor antagonists improve outcomes after MI when the ejection fraction is 35 percent or less with either heart failure symptoms or diabetes, as shown in the EMPHASIS-HF trial for eplerenone and the EPHESUS trial for eplerenone post-MI. Digoxin and furosemide relieve symptoms but do not reduce mortality, and amiodarone is reserved for ventricular arrhythmias, not routine post-MI therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.