Cardiometabolic outcomes with dapagliflozin after myocardial infarction by baseline ejection fraction: DAPA-MI.

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
David Erlinge, Stefan James, John Deanfield, Niclas Eriksson, Mark de Belder, Monér Alchay, David Austin, Daniel A Jones, Annica Ravn-Fischer, Sofia Sederholm Lawesson, Nikunj Shah, Julian W Strange, Karolina Szummer, Wilhelm Ridderstråle, Ehsan Parvaresh Rizi, Anna Maria Langkilde, Peter A Johansson, Darren K McGuire, Jonas Oldgren, Robert F Storey
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引用次数: 0

Abstract

Aims: In the randomized DAPA-MI clinical trial, 10 mg of dapagliflozin once daily improved cardiometabolic outcomes versus placebo after acute myocardial infarction (MI) in patients without established diabetes or heart failure (HF). We assessed associations between baseline left ventricular ejection fraction (LVEF) and cardiometabolic outcomes in DAPA-MI.

Methods: The primary outcome, assessed using the win ratio method, was the hierarchical composite of death, hospitalization for HF, non-fatal MI, atrial fibrillation/flutter, Type 2 diabetes, New York Heart Association classification at last visit and body weight decrease of ≥5% from baseline to last visit. For the present analysis, patients were categorized using LVEF at randomization (<50% or ≥50%).

Results: Of the DAPA-MI participants with available LVEF data who received ≥1 dose of study drug (n = 3751), 2913 (77.7%) had LVEF <50% and 838 (22.3%) had LVEF ≥50%. The primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.38 (95% CI: 1.21, 1.57; P < 0.001) in patients with LVEF <50% and 1.32 (1.00, 1.73; P = 0.048) in patients with LVEF ≥ 50% (P interaction = 0.76). In a sensitivity analysis excluding patients with LVEF <30%, the primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.40 (95% CI: 1.22, 1.61; P < 0.001). There were no significant interactions between baseline LVEF and any secondary outcomes.

Conclusions: Regardless of baseline LVEF, dapagliflozin resulted in significant cardiometabolic benefits versus placebo, although there was no impact on the composite of cardiovascular death or hospitalization for HF.

基线射血分数对心肌梗死后使用达格列净的心脏代谢结果的影响:DAPA-MI。
目的:在随机DAPA-MI临床试验中,在无糖尿病或心力衰竭(HF)的急性心肌梗死(MI)患者中,与安慰剂相比,每天一次10mg达格列净可改善心脏代谢结局。我们评估了基线左室射血分数(LVEF)与DAPA-MI患者心脏代谢结果之间的关系。方法:使用赢比法评估的主要终点是死亡、HF住院、非致死性心肌梗死、房颤/扑动、2型糖尿病、最后一次就诊时纽约心脏协会分类和体重从基线到最后一次就诊时下降≥5%的分层复合。在本分析中,随机分组时使用LVEF对患者进行分类(结果:在接受≥1剂量研究药物的具有可用LVEF数据的DAPA-MI参与者中(n = 3751), 2913(77.7%)具有LVEF。结论:无论基线LVEF如何,达格列净与安慰剂相比具有显着的心脏代谢益处,尽管对心血管死亡或HF住院的综合影响没有。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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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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