Effects of SGLT2 inhibitors on angiography-derived coronary microcirculatory resistance and clinical outcomes in patients with coronary heart disease and type 2 diabetes: A cohort study.

Background: Coronary microvascular dysfunction (CMD) is prevalent in patients with coronary heart disease (CHD) and Type 2 Diabetes (T2DM). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have cardioprotective effects, however, their impact on microcirculatory function is controversial. In this study, we systematically evaluated the effects of SGLT2i on microcirculatory function and clinical outcomes in patients with CHD and T2DM.

Methods: This single-center ambispective cohort study retrospectively screened patients with CHD and T2DM who underwent two coronary angiographies from March 2021 to December 2023. Propensity score matching was used to equilibrate baseline factors between two groups: with 106 patients receiving dapagliflozin therapy (experimental group) and 106 patients not receiving dapagliflozin (control group). The retrospective part assessed the effect of SGLT2i on coronary microcirculatory function in patients with CHD and T2DM using the change in Angiography-derived Coronary Microcirculatory Resistance (AMR) from baseline to 12±1 months after treatment as the primary endpoint. The prospective portion of the study followed patients for 15 months to assess clinical outcomes. The study was registered with the China Clinical Trial Registry (ChiCTR2400085512).

Results: Baseline characteristics were comparable between groups. The experimental group showed reductions in AMR (from 2.63 to 2.41, P < 0.05). In contrast, the control group exhibited increases in AMR (from 2.58 to 2.78, P < 0.05). Post-treatment intergroup comparisons showed lower AMR in the experimental group (P < 0.05). At 15-month follow-ups, the experimental group had higher 6-minute walk distance (6MWD) and scores across all domains of the Seattle Angina Questionnaire (SAQ) and 36-items Short-form Health Survey (SF-36) (P < 0.05). An exploratory survival analysis revealed statistically significant differences in the survival curves of the two groups (log-rank P = 0.014).

Conclusion: This study found that SGLT2i may confer beneficial effects on coronary microcirculatory function, exercise capacity, quality of life, and survival in patients with CHD and T2DM. This provides new evidence for the improvement of coronary microcirculatory function by SGLT2i.

Trial registration: China Clinical Trial Registry Identifier ChiCTR2400085512 (Registration date June 11, 2024).