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SGLT2 inhibition in acute myocardial infarction with left ventricular systolic dysfunction
Session:
Comunicações Orais (Sessão 2) - DAC e Cuidados Intensivos 1: Síndromes Coronárias Agudas
Speaker:
Beatriz Valente Silva
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Beatriz Valente Silva; Pedro Alves da Silva; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; João r Agostinho; Fausto j Pinto; Dulce Brito
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>The EMPEROR-Reduced and the DAPA-HF trials showed positive effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on heart failure (HF) admissions and cardiovascular mortality, establishing this class of drugs as part of the foundational therapy (FT) in patients (pts) with HF and reduced left ventricular ejection fraction (LVEF). However, their effect in the setting of acute myocardial infarction (AMI) is not documented.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Quasi-experimental study that included consecutive pts started on SGLT2i (empagliflozin or dapagliflozin) during an index hospitalization due to AMI<strong> </strong>complicated by reduced LVEF (< 50%). The control group consisted of pts admitted due to AMI not treated with SGLT2i, matched for AMI type, Killip-Kimball classification (KK), LVEF, at-discharge NYHA functional class, age, number of diseased coronary vessels and gender. The primary outcome was 1-year all-cause mortality, HF hospitalization or outpatient treated HF decompensation, whichever occurred first. For statistical analysis Chi-square, Mann-Whitney test, Cox regression and Kaplan-Meier survival analysis were used.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Both groups included 46 pts (mean age: 65±12 years; female: 26%). There were no statistically significant differences between groups regarding co-morbidities, except diabetes (80.4% in the SGLT2i group vs 30.4%, p<0.001). Populations were homogeneous regarding LVEF (38±8% vs 36±10%), AMI type (76.1% pts had STEMI in both groups), admission KK (KK 1: 65.2% in both groups), NYHA II (54.3% vs 56.5%) and single vessel coronary artery disease (63.04% in both groups): anterior descending artery (62.2% vs 69.5%) and right coronary artery (21.7% vs 17.3%) disease. There were no differences regarding other FT classes at discharge nor regarding NTproBNP or creatinine.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up (FUP) of 286±107 days, the primary outcome was significantly less frequent in the SGLT2i group (6.5% vs 26%; HR 0,18; IQR 0.05-0.7; p=0.014) – Figure 1. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At the end of FUP both groups were homogeneous in terms of ongoing FT, although a trend was observed toward higher prescription rates of mineralocorticoid receptor antagonists and sacubitril/valsartan in the SGLT2i group. NYHA functional class was significantly lower in the SGLT2i group (p=0.022).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> This quasi-experimental study suggests that early initiation of SGLT2i in pts with AMI and reduced LVEF may lead to lower HF related events, lower all-cause mortality and better functional class 1 year after initial coronary event. </span></span></p>
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