Timing of SGLT2i initiation after acute myocardial infarction

Cardiovascular Diabetology

Research

Jolanta Siller-Matula¹  Abderrahim Oulhaj²  Martin Benedikt³  Ewald Kolesnik³  Dirk von Lewinski³  Nora Schwegel³  Markus Wallner³  Faisal Aziz⁴  Peter N. Pferschy⁴  Norbert J. Tripolt⁴  Friederike von Lewinski⁴  Harald Sourij⁵  Deddo Moertl⁶  Rury R. Holman⁷ 

[1] Department of Cardiology, Medical University of Vienna, Vienna, Austria;Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE;Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria;Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria;Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria;Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria;Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria;Karl Landsteiner University of Health Sciences, 3050, Krems, Austria;Department of Internal Medicine 3, University Hospital St. Poelten, 3100, St. Poelten, Austria;Radcliffe Department of Medicine, University of Oxford, Oxford, UK;

关键词: Myocardial infarction;    SGLT2i;    Timing;    Clinical trial;   

DOI  :  10.1186/s12933-023-02000-5

 received in 2023-07-28, accepted in 2023-09-19,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered “sick days drugs” and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation.Methods and resultsThe EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: − 69.1; − 48.1) in the early group compared to 61.0% (− 76.0; − 41.4) in the intermediate and 61.9% (− 70.8; − 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups—initiation time interaction (pint = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected.ConclusionVery early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2–3 days.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 3