Outcomes in diabetic patients treated with SGLT2-Inhibitors with acute myocardial infarction undergoing PCI: The SGLT2-I AMI PROTECT Registry

To investigate in-hospital and long-term prognosis in T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-I versus other oral anti-diabetic agents (non-SGLT2-I users). In this multicenter international registry all consecutive diabetic AMI patients undergoing percutane...

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Published in:Pharmacological research Vol. 187; p. 106597
Main Authors: Paolisso, Pasquale, Bergamaschi, Luca, Gragnano, Felice, Gallinoro, Emanuele, Cesaro, Arturo, Sardu, Celestino, Mileva, Niya, Foà, Alberto, Armillotta, Matteo, Sansonetti, Angelo, Amicone, Sara, Impellizzeri, Andrea, Esposito, Giuseppe, Morici, Nuccia, Andrea, Oreglia Jacopo, Casella, Gianni, Mauro, Ciro, Vassilev, Dobrin, Galie, Nazzareno, Santulli, Gaetano, Marfella, Raffaele, Calabrò, Paolo, Pizzi, Carmine, Barbato, Emanuele
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01.01.2023
Subjects:
Acute Kidney Injury - etiology
Acute myocardial infarction
Arrhythmias
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
HF hospitalization
Humans
Myocardial Infarction - drug therapy
Outcomes
Percutaneous Coronary Intervention - adverse effects
Registries
Risk Factors
SGLT2-I
Sodium-Glucose Transporter 2 Inhibitors - adverse effects
Treatment Outcome
NSTEMI
T2DM
HF hospitalization
Outcomes
SGLT2-I
OAD
PCI
STEMI
CABG
Acute myocardial infarction
AMI
HF
Arrhythmias
RWMA
ISSN:1043-6618, 1096-1186, 1096-1186
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Summary:To investigate in-hospital and long-term prognosis in T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-I versus other oral anti-diabetic agents (non-SGLT2-I users). In this multicenter international registry all consecutive diabetic AMI patients undergoing percutaneous coronary intervention between 2018 and 2021 were enrolled and, based on the admission anti-diabetic therapy, divided into SGLT-I users versus non-SGLT2-I users. The primary endpoint was defined as a composite of cardiovascular death, recurrent AMI, and hospitalization for HF (MACE). Secondary outcomes included i) in-hospital cardiovascular death, recurrent AMI, occurrence of arrhythmias, and contrast-induced acute kidney injury (CI-AKI); ii) long-term cardiovascular mortality, recurrent AMI, heart failure (HF) hospitalization. The study population consisted of 646 AMI patients (with or without ST-segment elevation): 111 SGLT2-I users and 535 non-SGLT-I users. The use of SGLT2-I was associated with a significantly lower in-hospital cardiovascular death, arrhythmic burden, and occurrence of CI-AKI (all p < 0.05). During a median follow-up of 24 ± 13 months, the primary composite endpoint, as well as cardiovascular mortality and HF hospitalization were lower for SGLT2-I users compared to non-SGLT2-I patients (p < 0.04 for all). After adjusting for confounding factors, the use of SGLT2-I was identified as independent predictor of reduced MACE occurrence (HR=0.57; 95%CI:0.33–0.99; p = 0.039) and HF hospitalization (HR=0.46; 95%CI:0.21–0.98; p = 0.041). In T2DM AMI patients, the use of SGLT2-I was associated with a lower risk of adverse cardiovascular outcomes during index hospitalization and long-term follow-up. Our findings provide new insights into the cardioprotective effects of SGLT2-I in the setting of AMI. Data are part of the observational international registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov Identifier: NCT05261867. [Display omitted] •Multicenter international registry of diabetic AMI patients undergoing PCI divided into SGLT-I users versus non-SGLT2-I users.•A mitigated negative LV remodeling was detected in patients treated with SGLT2-I.•SGLT2-I were associated with a lower in-hospital cardiovascular death and arrhythmic burden.•In SGLT2-I users cardiovascular mortality, HF hospitalization and MACE were significantly lower compared to no-SGLT2-I patients.
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The first two authors contributed equally to this work.
The last two authors contributed equally to this work.
PP and LB contributed conception and design of the study; PP, LB, AC, NM, FG, MA, AS, AS, GE and AI organized the database and collected data; LB and EG performed the statistical analysis; PP and LB wrote the first draft of the manuscript; FG and AC wrote sections of the manuscript. GS, CS, AF, GC, CM, RM, NM, JAO, DV, PC, EB and CP revised the article and approved the final version of the manuscript. All authors contributed to manuscript revision, read and approved the submitted version.
Author contributions
ISSN:1043-6618
1096-1186
1096-1186
DOI:10.1016/j.phrs.2022.106597