SGLT2 inhibitors and cardiovascular outcomes in patients with acute myocardial infarction: a retrospective cohort analysis.

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Xuan Ci Mee, Ghee Kheng Lim, Ramzi Ibrahim, Hoang Nhat Pham, Mahmoud Abdelnabi, Mohamed Allam, George Bcharah, Min Choon Tan, Timothy Barry, Juan Farina, Chadi Ayoub, Reza Arsanjani, Kwan Lee
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引用次数: 0

Abstract

Aims: Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) improve heart failure (HF) outcomes but their effects on acute myocardial infarction (AMI) remain poorly characterized. This study aimed to evaluate the 1-year cardiovascular outcomes of SGLT2-Is among patients with AMI.

Methods and results: We conducted an observational, retrospective cohort study using TriNetX data, including patients aged ≥18 with AMI identified via ICD-10 codes regardless of left ventricular ejection fraction (LVEF), categorized by SGLT2-Is use. Propensity score matching (PSM) was performed to balance baseline demographics, comorbidities, and medication use. Adjusted odds ratios (aORs) were estimated for the primary outcome (recurrent AMI) and the secondary outcomes (acute HF hospitalizations, stroke, all-cause hospitalizations, all-cause mortality, new-onset atrial fibrillation, and cardiac arrest). After PSM, 89 554 patients were analysed (44 777 SGLT2-Is users; 44 777 non-users). The mean age was ∼68 years in both cohorts with a similarly high burden of cardiovascular comorbidities. Mean follow-up duration was 290.854 days for SGLT2-Is users and 284.465 days for non-users. SGLT2-Is use was linked to lower rates of recurrent AMI [aOR: 0.459; 95% confidence interval (CI): 0.367-0.551], all-cause hospitalizations (aOR: 0.782; 95% CI: 0.762-0.803), all-cause mortality (aOR: 0.640; 95% CI: 0.612-0.670), and cardiac arrest (aOR: 0.834; 95% CI: 0.773-0.900). No differences were observed in acute HF hospitalizations, new-onset atrial fibrillation, or stroke.

Conclusion: SGLT2-Is are associated with improved cardiovascular outcomes in patients with AMI, including reductions in recurrent AMI, all-cause hospitalizations and mortality, and cardiac arrest. These findings emphasize the need for prospective clinical trials involving patients with AMI and other cardiovascular comorbidities, regardless of LVEF, to confirm these results.

SGLT2抑制剂与急性心肌梗死患者心血管预后:回顾性队列分析
目的:钠-葡萄糖共转运蛋白2抑制剂(SGLT2-Is)改善心力衰竭(HF)的结局,但其对急性心肌梗死(AMI)的影响仍不清楚。本研究旨在评估AMI患者中SGLT2-Is一年的心血管结局。方法和结果:我们使用TriNetX数据进行了一项观察性、回顾性队列研究,纳入了年龄≥18岁、通过ICD-10编码确诊的AMI患者,无论左室射血分数(LVEF)如何,按SGLT2-Is使用分类。采用倾向评分匹配(PSM)来平衡基线人口统计学、合并症和药物使用。对主要结局(AMI复发)和次要结局(急性心衰住院、卒中、全因住院、全因死亡率、新发房颤和心脏骤停)的调整优势比(aORs)进行了估计。PSM后,分析了89,554例患者(44,777例SGLT2-Is使用者;44777吸毒者)。两个队列的平均年龄约为68岁,心血管合并症的负担相似。SGLT2-Is使用者的平均随访时间为290.854天,非使用者的平均随访时间为284.465天。使用SGLT2-Is与较低的AMI复发率相关(aOR: 0.459;95% CI: 0.367-0.551),全因住院率(aOR: 0.782;95% CI: 0.762-0.803),全因死亡率(aOR: 0.640;95% CI: 0.612-0.670)和心脏骤停(aOR: 0.834;95% ci: 0.773-0.900)。在急性心衰住院、新发房颤或中风方面没有观察到差异。结论:SGLT2-Is与AMI患者心血管预后的改善相关,包括AMI复发、全因住院和死亡率以及心脏骤停的减少。这些发现强调有必要对AMI和其他心血管合并症患者进行前瞻性临床试验,无论左心室射血分数如何,以证实这些结果。
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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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