Ferreira JP, et al. – In the REMINDER trial, eplerenone was tested for impact in patients with an acute ST–elevation Myocardial Infarction (STEMI) without known heart failure (HF). Evidence reported that eplerenone effectively attenuated procollagen type III N-terminal propeptide (PIIINP) levels when baseline values were above the median and, might limit extracellular matrix marker (ECMM) formation in post–myocardial infarction (MI) without HF.

Methods

• The REMINDER trial was conducted to assess the impact of eplerenone in patients with an acute ST-elevation Myocardial Infarction (STEMI) without known heart failure (HF), when initiated within 24 h of symptom onset.
• The primary outcome was almost totally (>90%) driven by natriuretic peptide (NP) thresholds after 1-month post-MI (it also included a composite of cardiovascular death or re-hospitalization or new onset HF or sustained ventricular tachycardia or fibrillation or LVEF ≤40% after 1-month post-MI).
• In this secondary analysis, researchers evaluated the extracellular matrix marker (ECMM) levels with regards to patients` characteristics; determinants; and eplerenone effect.

Results

• Data reported that serum levels of ECMM were measured in 526 (52%) of the 1012 patients enrolled in the REMINDER trial.
• Researchers noted that patients with procollagen type III N-terminal propeptide (PIIINP) above the median were older and had worse renal function (p < 0.05).
• They also observed that worse renal function was associated with increased levels of PIIINP (standardized β ≈ 0.20, p < 0.05).
• In addition, data highlighted that eplerenone reduced PIIINP when the levels of this biomarker were above the median of 3.9 ng/mL (0.13 ± 1.48 vs. -0.37 ± 1.56 ng/mL, p = 0.008).
• Results demonstrated that higher levels of PIIINP were independently associated with higher proportion of NP above the prespecified thresholds (HR = 1.95, 95% CI 1.16–3.29, p = 0.012).