SPC365

Real-life impact of sodium-glucose co-transporter-2 inhibitors after acute coronary syndrome

Session: Sessão de Posters 09 - Epidemiologia e formação médica
Speaker: Catarina Ribeiro Carvalho

Congress: CPC 2024
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Cartazes
FP Number: ---
Authors: Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Isabel Martins Moreira; Luís Sousa Azevedo; Ana Baptista; Ilídio Moreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended for patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF), to reduce the risk of HF hospitalization and cardiovascular mortality. However, its benefit after acute coronary syndromes (ACS) has not been established.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> to evaluate the prognostic impact of SGLT2i after ACS.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> this was a single center retrospective study of patients hospitalized with ACS<span style="color:black">, </span>included in the Portuguese Registry of Acute Coronary Syndromes, <span style="color:black">between January 2021 and December 2022</span>. Patients previously taking SGLT2i were excluded. The impact of SGLT2i prescription at discharge on the composite endpoint of recurrent acute myocardial infarction, unplanned revascularization or cardiovascular death was evaluated. Additionally, the incidence of HF outcomes was compared between the two groups.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>a total of 157 patients was included, 27.4% with SGLT2i prescription. Mean follow-up duration was 20.9&plusmn;8.1 months. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Apart from being slightly older than patients without SGLT2i prescription (69.6&plusmn;11.8 vs. 63.8&plusmn;13.1 years, p=0.01) and the higher prevalence of diabetes mellitus (67.4 vs. 14.9%) and arterial hypertension (76.7 vs. 52.5%, p=0.004), there were no other significant differences in the baseline characteristics of the two groups. LVEF was also similar between groups (50.4&plusmn;14.7 vs. 51.4&plusmn;8,7%, p=0.66), as was discharge medication.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">SGLT2i didn&rsquo;t significantly reduce the incidence of the composite endpoint (p=0.18), which occurred in 12.8% of patients in the SGLT2i group and in 6.4% of patients without SGLT2i prescription. In a multivariate analysis, accounting for possible confounders including diabetes mellitus and chronic kidney disease, only previous HF (HR = 37.0, 95%CI 6.12-220.2) and severely reduced LVEF (HR = 14.0, 95%CI 2.07-94.37) were independent predictors of this endpoint. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">When analyzing the individual components of the primary endpoint, SGLT2i didn&rsquo;t demonstrate a significant improvement in recurrent acute myocardial infarction (p=0.09), unplanned revascularization (p=0.85) or cardiovascular death (p=0.09). These findings remained consistent similar in the subgroup analysis of patients with reduced LVEF, with SGLT2i exhibiting a neutral effect in each individual outcome.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding HF outcomes, SGLT2i didn&rsquo;t lead to a significant increase in LVEF (variation of mean LVEF of 3,1&plusmn;7.2 vs. 7.5&plusmn;8,8%, p=0.06) or a reduction of HF events (HF hospitalizations, urgent HF visits or unplanned outpatient HF visits) (p=0.14). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>SGLT2i initiation after ACS didn&rsquo;t reduce the incidence of the composite endpoint of recurrent acute myocardial infarction, unplanned revascularization or cardiovascular death, regardless of diabetes mellitus or LVEF. Additionally, SGLT2i didn&rsquo;t exhibit a significant impact in HF outcomes after ACS.</span></span></p>