Dapagliflozin protects against MACE in acute MI patients undergoing PCI: Study

The incidence of MACE in AMI patients remains high despite extensive progress in interventional therapy. Several risk factors, such as atrial fibrillation, chronic kidney disease (CKD), diabetes, low ejection fraction, high burden of coronary disease, and advanced age, may worsen the prognosis of such patients. SGLT2 inhibitors have been reported to improve cardiorenal endpoints in type 2 diabetes (T2DM) patients with chronic heart failure with reduced ejection fraction (HFrEF). However, there is no clarity on whether SGLT2i can improve outcomes in AMI patients.

Considering the above, Yuan Ji, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, People's Republic of China, and colleagues aimed to investigate the association between DAPA intervention and adverse events in acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI) in a single-center retrospective analysis study.

The study included 786 AMI patients from January 2019 to August 2021 who were not given DAPA at discharge. The study's primary endpoint was the composite of MACE, including heart failure, overall deaths, nonfatal stroke, nonfatal MI, and unplanned repeat revascularization (URR). The researchers also compared the differences between the atherogenic plasma index (AIP) and the triglyceride glucose (TyG) index both during hospitalization and 12 months after discharge.

The study yielded the following findings:

· 130 patients had MACE (118 in the DAPA-free group and 12 in the DAPA group) during a median follow-up of 23 months.

· Kaplan–Meier survival analyses revealed that the cumulative incidence of MACE, heart failure, nonfatal MI, and URR was higher in the DAPA-free group.

· In addition, the multivariate Cox analysis showed that DAPA was significantly associated with the reduced risk of MACE (hazard ratio = 0.170).

· Considering each adverse event, the DAPA-free group was associated with heart failure, nonfatal MI, and URR in multivariate Cox regression analyses.

· Stratification analyses suggested that DAPA has a robust protective effect in patients with AMI of advanced age with concomitant diabetes or those not on angiotensin receptor enkephalinase inhibitors.

· The TyG index and AIP of the patients 12 months after DAPA administration at discharge were significantly lower than those during hospitalization.

"The findings showed that the administration of DAPA was linked to reduced MACE in AMI patients, specifically in those with hypertension and advanced age and those who did not receive ARNI," the researchers wrote. "Moreover, the study revealed that 12 months after discharge, DAPA administration remarkably decreased AIP and the TyG index."

Reference:

Zhu, Y., Zhang, Jl., Yan, Xj. et al. Effect of dapagliflozin on the prognosis of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Cardiovasc Diabetol 21, 186 (2022). https://doi.org/10.1186/s12933-022-01627-0