EPHESUS Post-MI Eplerenone Response Score

EPHESUS Post-MI Eplerenone Response Score: explanation and clinical context This tool implements two things: (1) an objective eligibility check based on the original EPHESUS trial inclusion criteria — specifically enrollment 3–14 days after acute myocardial infarction (MI) with left ventricular ejection fraction (LVEF) ≤40% and either signs/symptoms of heart failure or diabetes — and (2) an exploratory, unvalidated response index that weights several clinical features commonly associated with higher event risk and with observed subgroup/biomarker responses in post-hoc EPHESUS analyses. The original EPHESUS randomized trial demonstrated that initiation of eplerenone (25 mg daily, titrated) in appropriately eligible post-MI patients produced roughly a 15% relative reduction in all-cause mortality compared with placebo. This calculator does not attempt to produce a validated individual absolute mortality estimate; rather, it (A) confirms whether a patient matches the trial population and (B) provides an exploratory point index to help clinicians identify patients whose baseline characteristics resemble higher-risk subgroups that have been associated with larger absolute event rates in published analyses.

Use this tool as an adjunct to clinical judgment; decisions about starting mineralocorticoid receptor antagonists should include assessment of renal function, potassium, concomitant therapies (ACEi/ARB), blood pressure, and monitoring capability.