Effect of empagliflozin on total myocardial infarction events by type and additional coronary outcomes: insights from the randomized EMPA-REG OUTCOME trial.

IF 8.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Diabetology Pub Date : 2024-07-11 DOI:10.1186/s12933-024-02328-6

David Fitchett, Bernard Zinman, Silvio E Inzucchi, Christoph Wanner, Stefan D Anker, Stuart Pocock, Michaela Mattheus, Ola Vedin, Søren S Lund

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引用次数: 0

Abstract

Background: The effect of empagliflozin, a sodium-glucose-co-transporter-2 inhibitor, on risk for myocardial infarction has not been fully characterized.

Methods: This study comprised prespecified and post-hoc analyses of the EMPA-REG OUTCOME trial in which 7020 people with type 2 diabetes (T2D) and cardiovascular disease [mostly atherosclerotic (ASCVD)] were randomized to empagliflozin or placebo and followed for a median 3.1 years. We assessed the effect of empagliflozin on total (first plus recurrent) events of centrally adjudicated fatal and non-fatal myocardial infarction (MI) using a negative binomial model with robust confidence intervals (CI) that preserves randomization and accounts for the within-patient correlation of multiple events. Post hoc, we analyzed types of MI: type 1 (related to plaque-rupture/thrombus), type 2 (myocardial supply-demand imbalance), type 3 (sudden-death related, i.e. fatal MI), type 4 (percutaneous coronary intervention-related), and type 5 (coronary artery bypass graft-related). MIs could be assigned to > 1 type.

Results: There were 421 total MIs (including recurrent); 299, 86, 26, 19, and 1 were classified as type 1, 2, 3, 4, and 5 events, respectively. Overall, empagliflozin reduced the risk of total MI events by 21% [rate ratio for empagliflozin vs. placebo, 0.79 (95% CI, 0.620-0.998), P = 0.0486], largely driven by its effect on type 1 [rate ratio, 0.79 (95% CI, 0.61-1.04)] and type 2 MIs [rate ratio, 0.67 (95% CI, 0.41-1.10)].

Conclusions: In T2D patients with ASCVD, empagliflozin reduced the risk of MIs, with consistent effects across the two most common etiologies, i.e. type 1 and 2.

Trail registration: URL: https://www.

Clinicaltrials: gov ; Unique identifier: NCT01131676.

查看原文本刊更多论文

恩格列净对各类型心肌梗死总事件和其他冠心病结局的影响：随机 EMPA-REG OUTCOME 试验的启示。

背景钠-葡萄糖协同转运体-2抑制剂empagliflozin对心肌梗死风险的影响尚未完全定性：这项研究包括对EMPA-REG OUTCOME试验的预设分析和事后分析，在这项试验中，7020名2型糖尿病（T2D）和心血管疾病（主要是动脉粥样硬化性疾病（ASCVD））患者被随机分配到empagliflozin或安慰剂中，并接受了中位3.1年的随访。我们评估了empagliflozin对集中判定的致死性和非致死性心肌梗死（MI）总事件（首次和复发）的影响，采用的是带稳健置信区间（CI）的负二项模型，该模型保留了随机性，并考虑了患者内部多个事件的相关性。事后，我们分析了心肌梗死的类型：1 型（与斑块破裂/血栓有关）、2 型（心肌供需失衡）、3 型（与猝死有关，即致命心肌梗死）、4 型（与经皮冠状动脉介入治疗有关）和 5 型（与冠状动脉旁路移植术有关）。心肌梗死可分为>1种类型：共发生 421 例心肌梗死（包括复发），其中 299 例、86 例、26 例、19 例和 1 例分别属于 1 型、2 型、3 型、4 型和 5 型。总体而言，empagliflozin可将总心肌梗死事件风险降低21%[empagliflozin与安慰剂的比率比为0.79（95% CI，0.620-0.998），P = 0.0486]，这主要是由于其对1型心肌梗死[比率比为0.79（95% CI，0.61-1.04）]和2型心肌梗死[比率比为0.67（95% CI，0.41-1.10）]的影响：在患有 ASCVD 的 T2D 患者中，empagliflozin 可降低心肌梗死的风险，对两种最常见的病因（即 1 型和 2 型）具有一致的效果：URL: https://www.Clinicaltrials: gov ; Unique identifier：NCT01131676.

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来源期刊

Cardiovascular Diabetology 医学-内分泌学与代谢

CiteScore

12.30

自引率

15.10%

发文量

240

审稿时长

1 months

期刊介绍： Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.