Abstract
Whether sodium-glucose co-transporters-2 (SGLT2) inhibitors have beneficial effects on cardiovascular (CV) events and mortality if given within few days from acute myocardial infarction (AMI) is unknown. The DAPA-MI trial (n= 4,107) is the only available study designed to evaluate the impact of administration of dapagliflozin on CV outcomes and mortality if started within 10 days from occurrence of an AMI. Using the win-ratio approach, the primary outcome of the DAPA-MI trial was the hierarchical composite of death, hospitalization for heart failure (HFF), nonfatal myocardial infraction (MI), atrial fibrillation/flutter, incident type 2 diabetes, New York Heart Association Functional Class (NYHAFC) at the last visit, and weight decrease of 5% or greater. After a median duration of follow-up of 11.6 months, the win ratio was in favor of dapagliflozin being 1.34 (95% CI, 1.20 to 1.50, P< 0.001). This improvement in win ratio was mainly attributed to weight reduction (-1.65 kg versus placebo), 47% lower rates of incident type 2 diabetes [hazard ratio (HR) 0.53, 95% CI, 0.36 to 0.77)], and mild amelioration in NYHAFC. However, there was tendency toward increase in all-cause death (HR 1.22, 95% CI, 0.77 to 1.92), CV death (HR 1.15, 95% CI, 0.66 to 2.01), all-cause hospitalization (HR 1.12, 95% CI, 0.98 to 1.29), and non-fatal MI (HR 1.11, 95% CI, 0.72 to 1.71) with dapagliflozin. In the EMMY trial, empagliflozin when initiated within 3 days of percutaneous coronary intervention (PCI) in patients with AMI decreased serum levels of N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) by 15% and marginally improved left ventricular ejection fraction (LVEF) by 1.5% compared with placebo. The ongoing EMPACT-MI trial should clarify the effects of empagliflozin on hard CV outcomes and mortality in patients with recent AMI. In conclusion, current data suggests that early use of SGLT2 inhibitors within days after acute MI may reduce incidence of type 2 diabetes and body weight, but it was associated with a trend toward increased all-cause death, CV death, and MI. Further studies are needed before recommending the early initiation of SGLT2 inhibitors following AMI.
Keywords
Acute myocardial infarction, Dapagliflozin, Empagliflozin, DAPA-MI, EMPACT-MI, Mortality