Usefulness of Matrix Metalloproteinase-9 Plasma Levels to Identify Patients With Preserved Left Ventricular Systolic Function After Acute Myocardial Infarction.

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Usefulness of Matrix Metalloproteinase-9 Plasma Levels to Identify Patients With Preserved Left Ventricular Systolic Function After Acute Myocardial Infarction Who Could Benefit from Eplerenone Nikolaos Kampourides, MD, Dimitrios Tziakas, PhD, Georgios Chalikias, PhD, Dimitrios Papazoglou, PhD, Efstratios Maltezos, PhD, David Symeonides, MD, Stavros Konstantinides, PhD American Journal of Cardiology Volume 110, Issue 8, Pages 1085-1091 (October 2012) DOI: 10.1016/j.amjcard.2012.05.049 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 Flow diagram of study selection (S), randomization (R), and follow-up. Peripheral blood samples for measurement of blood chemistry (potassium and renal function) were obtained on day 7 after the index event (acute myocardial infarction) and at each follow-up visit (months 1, 6, 12, 18, and 24). Blood sampling for matrix metalloproteinase-9 assessment and echocardiographic examination for left ventricular ejection fraction determination were performed only on day 7 and at 12-month follow-up visit. *Patients (pts) were randomized to receive or not eplerenone on day 7 after the index event. †Three hundred three patients represent the intention-to-treat study population after exclusion of patients not fulfilling adequate data monitoring criteria. During follow-up, of 201 patients receiving eplerenone, 27 patients (13%) discontinued the study medication (9 [4%] because of hyperkalemia, 16 [8%] because of poor adherence, and 2 [1%] because of gynecomastia). Tx = treatment. American Journal of Cardiology 2012 110, 1085-1091DOI: (10.1016/j.amjcard.2012.05.049) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 Kaplan–Meier estimates of cumulative event-free survival rate between patients with baseline low (gray line) and high (black line) matrix metalloproteinase-9 plasma levels (cutoff 12.7 ng/ml). Event denotes death from cardiovascular causes, hospitalization for nonfatal acute myocardial infarction or unstable angina, or development of heart failure symptoms requiring hospitalization. American Journal of Cardiology 2012 110, 1085-1091DOI: (10.1016/j.amjcard.2012.05.049) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 3 Kaplan–Meier estimates of cumulative event-free survival rate between patients on eplerenone (black line) and patients without eplerenone treatment (gray line). Event denotes death from cardiovascular causes, hospitalization for nonfatal acute myocardial infarction or unstable angina, or development of heart failure symptoms requiring hospitalization. American Journal of Cardiology 2012 110, 1085-1091DOI: (10.1016/j.amjcard.2012.05.049) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 4 Kaplan–Meier estimates of cumulative event-free survival rate between patients on eplerenone (black lines) and patients without eplerenone treatment (gray lines) stratified according to baseline matrix metalloproteinase-9 levels (cutoff 12.7 ng/ml). Event denotes death from cardiovascular causes, hospitalization for nonfatal acute myocardial infarction or unstable angina, or development of heart failure symptoms requiring hospitalization. American Journal of Cardiology 2012 110, 1085-1091DOI: (10.1016/j.amjcard.2012.05.049) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 5 Changes of plasma levels of matrix metalloproteinase-9 from baseline (day 7) (white bars) to 12 months (gray bars) according to baseline levels above or below the cut-off value of 12.7 ng/ml. Median (horizontal line within bar), quartile (bar), and range (whisker) are depicted for matrix metalloproteinase-9 levels. *P value for observed change in matrix metalloproteinase-9 levels from baseline to 12 months. American Journal of Cardiology 2012 110, 1085-1091DOI: (10.1016/j.amjcard.2012.05.049) Copyright © 2012 Elsevier Inc. Terms and Conditions