Early Dapagliflozin in Non-diabetic Acute Myocardial Infarction Patients Post-PCI: Effects on Cardiovascular Outcomes and Left Ventricular Remodeling (EARLY DAPA-AMI).

IF 1.4 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the Saudi Heart Association Pub Date : 2025-10-31 eCollection Date: 2025-01-01 DOI:10.37616/2212-5043.1464

Hazem S E Salem, Ramzy M El-Mawardy, Mohamed E Zahran, Islam M Bastawy, Mina F Aziz, Abdelrahman E Attia

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引用次数: 0

Abstract

Background: Early initiation of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, may improve cardiovascular outcomes in acute myocardial infarction (AMI) by mitigating adverse remodeling and enhancing cardiac function.

Objectives: To assess dapagliflozin's impact on major adverse cardiovascular events (MACE) and left ventricular (LV) recovery in non-diabetic AMI patients using speckle-tracking echocardiography (STE).

Methods: This prospective, single-blinded randomized controlled trial (RCT) enrolled 200 non-diabetic patients with a first episode of AMI, including both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), following successful percutaneous coronary intervention (PCI). Participants received guideline-directed therapy and were randomized to dapagliflozin + standard care (Group I, n = 100) or standard care alone (Group II, n = 100). Echocardiographic parameters, including left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), LV end-diastolic volume (EDV), and LV end-systolic volume (ESV), were measured at baseline (1-3 days after acute myocardial infarction [AMI]) and at 6-month follow-up. Primary endpoint: 6-month MACE; secondary endpoints: cardiac function changes.

Results: MACE rates showed no significant difference (Group I: 4 % vs. Group II: 9 %; p = 0.152). Group I demonstrated superior cardiac improvement: higher LVEF (52.24 % vs. 47.66 %; p = 0.025), greater ESV reduction (-7.41 ± 13.20 mL vs. -2.52 ± 9.17 mL; p = 0.003), and improved GLS (-14.50 ± 3.27 % vs. -13.48 ± 3.77 %; p = 0.043). GLS change was significantly greater in Group I (Δ-1.467 ± 3.023 % vs. Δ-0.475 ± 2.252%; p = 0.009). Hypertensive and chronic kidney disease (CKD) subgroups showed enhanced myocardial recovery with dapagliflozin.

Conclusion: Early dapagliflozin in non-diabetic AMI patients did not reduce 6-month MACE but significantly improved LV function and remodeling, suggesting cardioprotective benefits beyond glycemic control, especially in high-risk subgroups.

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非糖尿病急性心肌梗死患者pci术后早期达格列净治疗：对心血管结局和左心室重构（早期DAPA-AMI）的影响

背景：早期使用钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂达格列净可能通过减轻不良重构和增强心功能来改善急性心肌梗死（AMI）的心血管结局。目的：利用斑点跟踪超声心动图（STE）评估达格列净对非糖尿病AMI患者主要不良心血管事件（MACE）和左心室（LV）恢复的影响。方法：这项前瞻性、单盲随机对照试验（RCT）纳入了200例首次AMI发作的非糖尿病患者，包括经皮冠状动脉介入治疗（PCI）成功后的st段抬高型心肌梗死（STEMI）和非st段抬高型心肌梗死（NSTEMI）。参与者接受指导治疗，随机分为达格列净+标准治疗组（I组，n = 100）或单独标准治疗组（II组，n = 100）。超声心动图参数包括左室射血分数（LVEF）、总纵向应变（GLS）、左室舒张末期容积（EDV）和左室收缩末期容积（ESV），在基线（急性心肌梗死[AMI]后1-3天）和6个月随访时进行测量。主要终点：6个月MACE；次要终点：心功能改变。结果：MACE率无显著性差异（1组：4% vs. 2组：9%；p = 0.152）。I组表现出较好的心脏改善：LVEF较高（52.24% vs. 47.66%; p = 0.025）， ESV降低较大（-7.41±13.20 mL vs. -2.52±9.17 mL; p = 0.003）， GLS改善（-14.50±3.27% vs. -13.48±3.77%;p = 0.043）。第一组GLS变化明显更大（Δ-1.467±3.023% vs. Δ-0.475±2.252%;p = 0.009）。高血压和慢性肾脏疾病（CKD）亚组显示达格列净增强心肌恢复。结论：早期应用达格列净治疗非糖尿病性AMI患者并没有降低6个月MACE，但可显著改善左室功能和重构，提示除血糖控制外的心脏保护作用，特别是在高危亚组中。

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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