A 58-year-old man had an anterior STEMI two weeks ago with left ventricular ejection fraction of 35% and Killip class II heart failure during admission. He has type 2 diabetes and serum creatinine of 1.1 mg/dL with potassium of 4.0 mEq/L. In addition to aspirin, statin, beta blocker and ACE inhibitor, which drug improves cardiovascular mortality in this setting?
- A Eplerenone ✓
- B Spironolactone
- C Digoxin
- D Furosemide
Correct answer: A. Eplerenone
Explanation
The EPHESUS trial showed that eplerenone added to standard therapy reduced cardiovascular mortality and sudden cardiac death in post-MI patients with left ventricular ejection fraction of 40 percent or less who had heart failure or diabetes, provided renal function and potassium allow its use. Spironolactone blocks aldosterone similarly but was not studied in this specific post-infarction population and causes gynecomastia. Digoxin and furosemide improve symptoms, not survival.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.