Ten days ago a 63-year-old man suffered an anterior STEMI treated conservatively. Echo shows an ejection fraction of 35% and he is clinically euvolemic. He has type 2 diabetes mellitus, potassium is 4.2 mEq/L and creatinine is 1.3 mg/dL. Which addition to his current regimen of aspirin, statin, metoprolol and ramipril has been shown to reduce all-cause mortality in this situation?
- A Furosemide
- B Eplerenone ✓
- C Amiodarone
- D Digoxin
Correct answer: B. Eplerenone
Explanation
In the EPHESUS trial, eplerenone started 3 to 14 days after MI in patients with an ejection fraction of 40% or less who had either clinical heart failure or diabetes reduced all-cause and cardiovascular mortality. This patient fits every criterion, with safe potassium and creatinine levels (eplerenone requires potassium below 5.0 mEq/L and creatinine below 2.5 mg/dL in men). Furosemide, digoxin and amiodarone improve symptoms or rhythm control in selected patients but have never demonstrated a mortality benefit in the post-infarction population.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.