Physicians' Academy for Cardiovascular Education

SGLT2i therapy improves NT-proBNP after AMI

Empagliflozin in acute myocardial infarction: the EMMY trial

Literature - Von Lewinski D, Kolesnik E, Tripolt NJ, et al. - Eur Heart J. 2022 Aug 29;ehac494 [Online ahead of print]. doi: 10.1093/eurheartj/ehac494

Introduction and methods


SGLT2is have been shown to reduce the risk of HF hospitalization and death in patients with symptomatic HF [1-4,5]. As 15% of MI patients develop symptomatic HF and/or reduced EF within 1 year [6,7], it is pivotal to determine whether initiating SGLT2i treatment early after an MI is effective and safe.

Aim of the study

The authors aimed to investigate the effect of empagliflozin treatment initiated within 72 hours after PCI on cardiac function and HF biomarkers in patients with a recent large acute MI (AMI).


The EMMY (Empagliflozin in Patients With Acute Myocardial Infarction) study was a prospective, multicenter, randomized, double-blind, placebo-controlled, phase 3 trial that was conducted in Austria. In this trial, 476 patients with a large AMI (creatine kinase >800 IU/L) and hs-troponin T/I level >10-fold the upper limit of normal were randomized to empagliflozin 10 mg once daily or placebo within 72 hours after PCI. In addition, patients received post-MI therapy as recommended by the 2017 ESC Guidelines [8]. Both patients with and without T2DM were included.


The primary efficacy endpoint was the change in NT-proBNP levels from randomization to week 26. Secondary efficacy endpoints included changes in functional and structural echocardiographic parameters, consisting of E/e’ ratio (to assess LV diastolic function), LV end-systolic volume (LVESV), and LV end-diastolic volume (LVEDV); changes in ketone body and glycated hemoglobin concentrations; and changes in body weight. Additional exploratory endpoints were hospitalization due to HF or other causes, duration of hospital stay, and all-cause mortality.

Key safety endpoints were the incidences of serious adverse events (SAEs), severe hypoglycemic events, genital infections, ketoacidotic events, and acute liver or renal injury.

Main results

Primary efficacy endpoint

Secondary efficacy endpoints

Safety endpoints


In patients with an AMI, empagliflozin treatment initiated within 72 hours after PCI was associated with a greater NT-proBNP reduction over 26 weeks compared with placebo. This decline was accompanied by an improvement in functional and structural echocardiographic parameters. In addition, there were no evident safety risks with empagliflozin.


Show references

Find this article online at Eur Heart J.

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