Effect of dapagliflozin on the no-reflow phenomenon in patients with acute myocardial infarction and type II diabetes mellitus.

Objective: This study aimed to assess the effect of dapagliflozin on the no-reflow phenomenon in patients with type II diabetes mellitus (T2DM) and acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI).

Methods: This single-center, observational cohort study included a total of 829 consecutive T2DM patients who were diagnosed with AMI and underwent PCI within 24 h of the onset of symptoms. Only patients using dapagliflozin (10 mg per day) for more than one year were considered as patients using dapagliflozin. The no-reflow phenomenon was defined as inadequate myocardial perfusion within a segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction, dissection, or residual stenosis after PCI.

Results: Four hundred and thirty-four patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), and 395 patients were diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Forward conditional logistic regression analysis demonstrated that the estimated glomerular filtration rate (OR = 0.940, 95% CI: 0.900 to 0.982, p = 0.006), SYNTAX score I (OR = 1.338, 95% CI: 1.179 to 1.520, p < 0.001), and dapagliflozin use (OR = 0.030, 95% CI: 0.004 to 0.228, p = 0.001) were independent predictors of the no-reflow phenomenon in STEMI. However, dapagliflozin use (OR = 0.112, 95% CI: 0.013 to 0.933, p = 0.043) was the only independent predictor of the no-reflow phenomenon in NSTEMI.

Conclusion: Lower rates of the no-reflow phenomenon were observed in T2DM patients taking dapagliflozin, diagnosed with AMI, and underwent PCI. However, this finding requires further investigation.