EMPACT-MI: A Study to Test Whether Empagliflozin Can Lower the Risk of Heart Failure and Death in People Who Had a Heart Attack (Myocardial Infarction)

Inclusion Criteria:

1. Of full age of consent (according to local legislation, at least ≥ 18 years) atscreening.

2. Signed and dated written informed consent in accordance with ICH-GCP and locallegislation prior to admission to the trial.

3. Male or female patients. Women of childbearing potential (WOCBP) must be ready andable to use highly effective methods of birth control per ICH M3 (R2) that result ina low failure rate of less than 1% per year when used consistently and correctly. Alist of contraception methods meeting these criteria is provided in the patientinformation.

4. Diagnosis of spontaneous Acute Myocardial Infarction (AMI): ST-Elevation MyocardialInfarction (STEMI) or Non-ST Elevation Myocardial Infarction (NSTEMI) withrandomisation to occur no later than 14 calendar days after hospital admission. Forpatients with an in-hospital Myocardial Infarction (MI) as qualifying event,randomization must still occur within 14 days of hospital admission.

5. High risk of HF, defined as EITHER

6. Symptoms (e.g. dyspnea; decreased exercise tolerance; fatigue), or signs ofcongestion (e.g. pulmonary rales, crackles or crepitations; elevated jugularvenous pressure; congestion on chest X-ray), that require treatment (e.g.augmentation or initiation of oral diuretic therapy; i.v. diuretic therapy;i.v. vasoactive agent; mechanical intervention etc.) at any time during thehospitalization.OR

7. Newly developed Left Ventricular Ejection Fraction (LVEF) < 45% as measured byechocardiography, ventriculography, cardiac Computer Tomography (CT), MagneticResonance Imaging (MRI) or radionuclide imaging during index hospitalisation.

8. In addition at least one of the following risk factors:

• Age > 65 years,

• Newly developed LVEF < 35%,

• Prior MI (before index MI) documented in medical records,

• Estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73m2 (using ChronicKidney Disease Epidemiology Collaboration Equation (CKD-EPI) formula based oncreatinine from local lab at any time during index hospitalisation),

• Atrial fibrillation (persistent or permanent ; if paroxysmal, only valid ifassociated with index MI),

• Type 2 diabetes mellitus (prior or new diagnosis),

• N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) >1,400 pg/mL for patientsin sinus rhythm, >2,800 pg/mL if atrial fibrillation; Brain Natriuretic Peptide (BNP) >350 pg/mL for patients in sinus rhythm, >700 pg/mL if atrialfibrillation, measured at any time during hospitalisation,

• Uric acid >7.5 mg/dL (>446 μmol/L), measured at any time duringhospitalisation,

• Pulmonary Artery Systolic Pressure [or right ventricular systolic pressure] >40mmHg (non-invasive [usually obtained from clinically indicated post-MIechocardiography] or invasive, at any time during hospitalisation),

• Patient not revascularized (and no planned revascularization) for the index MI (Includes e.g. patients where no angiography is performed, unsuccessfulrevascularization attempts, diffuse atherosclerosis not amenable forintervention; but does NOT include if revascularization was not performed dueto nonobstructive coronary arteries),

• 3-vessel coronary artery disease at time of index MI,

• Diagnosis of peripheral artery disease (extracoronary vascular disease, e.g.lower extremity artery disease or carotid artery disease).

Exclusion Criteria:

1. Diagnosis of chronic Heart Failure (HF) prior to index MI.

2. Systolic blood pressure < 90 mmHg at randomisation.

3. Cardiogenic shock or use of i.v. inotropes in last 24 hours before randomisation.

4. Coronary Artery Bypass Grafting planned at time of randomisation.

5. Current diagnosis of Takotsubo cardiomyopathy.

6. Any current severe (stenotic or regurgitant) valvular heart disease.

7. eGFR < 20 ml/min/1.73m2 (using CKD-EPI formula based on most recent creatinine fromlocal lab during index hospitalisation) or on dialysis.

8. Type I diabetes mellitus. Further exclusion criteria apply.