Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI.

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Francesco Fioretti, Javed Butler, Jacob A Udell, W Schuyler Jones, Mark C Petrie, Josephine Harrington, Michaela Mattheus, Johann Bauersachs, Antoni Bayes-Genis, Shaun G Goodman, Tomasz Gasior, James L Januzzi, Renato D Lopes, Piotr Ponikowski, Xavier Rossello, Morten Schou, Peter van der Meer, Dragos Vinereanu, Shelley Zieroth, Martina Brueckmann, Mikhail Sumin, Deepak L Bhatt, Adrian F Hernandez, Stefan D Anker
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引用次数: 0

Abstract

Background: In the EMPACT-MI trial, empagliflozin did not reduce the primary endpoint of all-cause mortality or hospitalization for heart failure (HHF) following acute myocardial infarction (AMI) but was associated with a risk reduction for HF events.

Objectives: This study aimed to evaluate whether the effect of empagliflozin on HF events is consistent in patients with and without type 2 diabetes and/or chronic kidney disease enrolled in the EMPACT-MI trial.

Methods: Post hoc analysis assessing the effect of empagliflozin on the primary endpoint and on HF events in AMI patients with and without an established recommendation for a sodium-glucose cotransporter-2 inhibitor (SGLT2i) (type 2 diabetes or chronic kidney disease).

Results: Of 6522 participants, 3489 (53%) did not have type 2 diabetes and/or chronic kidney disease. Those without these conditions were younger and with fewer comorbidities. No differences were observed for the primary endpoint. Empagliflozin reduced time to first HHF, total HHF, time to adverse event (AE) of HF (including outpatient HF events) and total AEs of HF similarly in patients with and without type 2 diabetes or chronic kidney disease. Total HHFs were 50 and 63 [adjusted event rate 1.74 and 2.31 events per 100 patient-years; rate ratio (RR) 0.75; 95% confidence interval (CI) 0.48, 1.18] in patients without and 98 and 144 (adjusted event rate 3.91 and 6.04 events per 100 patient-years; RR 0.65; 95% CI 0.45, 0.94; P for interaction = 0.61) in those with type 2 diabetes or chronic kidney disease in the empagliflozin and placebo arms, respectively. Any AEs, serious AEs and AEs leading to permanent study drug discontinuation were similar between treatment groups in both subgroups.

Conclusions: Empagliflozin improved HF outcomes similarly in patients after AMI with or without type 2 diabetes or chronic kidney disease.

恩帕列净治疗合并或不合并糖尿病和慢性肾病的心肌梗死:EMPACT-MI的见解
背景:在EMPACT-MI试验中,恩格列净没有降低急性心肌梗死(AMI)后心力衰竭(HHF)的全因死亡率或住院治疗的主要终点,但与HF事件的风险降低相关。目的:本研究旨在评估在EMPACT-MI试验中纳入的伴有和不伴有2型糖尿病和/或慢性肾脏疾病的患者中,恩格列净对HF事件的影响是否一致。方法:事后分析评估恩格列净对AMI患者的主要终点和心衰事件的影响,有或没有钠-葡萄糖共转运蛋白-2抑制剂(SGLT2i)(2型糖尿病或慢性肾脏疾病)的推荐。结果:6522名参与者中,3489名(53%)没有2型糖尿病和/或慢性肾脏疾病。没有这些症状的患者更年轻,合并症也更少。主要终点未观察到差异。恩帕列净在伴有和不伴有2型糖尿病或慢性肾脏疾病的患者中同样减少了首次HHF发生时间、总HHF发生时间、HF不良事件发生时间(包括门诊HF事件)和HF总AE。总hfs分别为50和63,调整后的事件发生率分别为1.74和2.31 / 100患者年;比率比(RR) 0.75;95%可信区间(CI) 0.48, 1.18],恩格列净组和安慰剂组2型糖尿病或慢性肾病患者的发生率分别为98和144(调整后的事件发生率分别为3.91和6.04 / 100患者-年;RR 0.65; 95% CI 0.45, 0.94;相互作用P = 0.61)。在两个亚组中,任何不良事件、严重不良事件和导致永久停药的不良事件在治疗组之间相似。结论:恩帕列净对AMI合并或不合并2型糖尿病或慢性肾脏疾病患者的HF预后有相似的改善。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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