Empagliflozin in acute Myocardial Infarction: the EMMY trial

Dirk von Lewinski, Ewald Kolesnik, Norbert J Tripolt, Peter N Pferschy, Martin Benedikt, Markus Wallner, Hannes Alber, Rudolf Berger, Michael Lichtenauer, Christoph H Saely, Deddo Moertl, Pia Auersperg, Christian Reiter, Thomas Rieder, Jolanta M Siller-Matula, Gloria M Gager, Matthias Hasun, Franz Weidinger, Thomas R Pieber, Peter M ZechnerMarkus Herrmann, Andreas Zirlik, Rury R Holman, Abderrahim Oulhaj, Harald Sourij

Research output: Journal article (peer-reviewed)Journal article

86 Citations (Scopus)


BACKGROUND AND AIMS: Sodium-glucose co-transporter 2 inhibition reduces the risk of hospitalisation for heart failure and for death in patients with symptomatic heart failure. However, trials investigating the effects of this drug class in patients following acute myocardial infarction are lacking.

METHODS: In this academic, multicentre, double-blind trial, patients (n = 476) with acute myocardial infarction accompanied by a large creatine kinase elevation (>800 U/L) were randomly assigned to empagliflozin 10 mg or matching placebo once-daily within 72 hours of percutaneous coronary intervention. The primary outcome was the N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) change over 26 weeks. Secondary outcomes included changes in echocardiographic parameters.

RESULTS: Baseline median (interquartile range) NT-proBNP was 1,294 (757-2,246) pg/ml. NT-proBNP reduction was significantly greater in the empagliflozin group, compared with placebo, being 15% lower (95% confidence interval [CI] -4.4% to -23.6%) after adjusting for baseline NT-proBNP, sex and diabetes status (p = 0.026). Absolute left ventricular ejection fraction improvement was significantly greater (1.5%, 95% CI 0.2% to 2.9%, p = 0.029), mean E/e' reduction was 6.8% (95% CI 1.3% to 11.3%, p = 0.015) greater, and left ventricular end-systolic and end-diastolic volumes were lower by 7.5 ml (95% CI 3.4 to 11.5 ml, p = 0.0003) and 9.7 ml (95% CI 3.7 to 15.7 ml, p = 0.0015), respectively, in the empagliflozin group, compared with placebo. Seven patients were hospitalised for heart failure (three in the empagliflozin group). Other predefined serious adverse events were rare and did not differ significantly between groups.

CONCLUSIONS: In patients with a recent myocardial infarction, empagliflozin was associated with a significantly greater NT-proBNP reduction over 26 weeks, accompanied by a significant improvement in echocardiographic functional and structural parameters.

Original languageEnglish
Pages (from-to)4421-4432
Number of pages12
JournalEuropean Heart Journal
Issue number41
Early online date29 Aug 2022
Publication statusPublished - 01 Nov 2022


  • Biomarkers
  • Heart Failure/drug therapy
  • Humans
  • Myocardial Infarction/drug therapy
  • Natriuretic Peptide, Brain
  • Peptide Fragments/therapeutic use
  • Stroke Volume
  • Ventricular Function, Left
  • Heart failure
  • Myocardial infarction
  • Empagliflozin
  • NT-proBNP
  • Randomised controlled trial
  • Clinical trial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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