Chen Dong-Yi, Wang Szu-Heng, Mao Chun-Tai, Tsai Ming-Lung, Lin Yu-Sheng, Chou Chung-Chuan, Wen Ming-Shien, Wang Chun-Chieh, Hsieh I-Chang, Hung Kuo-Chun, Chen Tien-Hsing
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Int J Cardiol. 2015 Feb 15;181:200-6. doi: 10.1016/j.ijcard.2014.12.029. Epub 2014 Dec 3.
The cardiovascular safety and efficacy of sitagliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor, in type 2 diabetic patients with chronic kidney disease (CKD) after acute myocardial infarction (AMI) are unclear.
We analyzed data from the Taiwan National Health Insurance Research Database between March 1st, 2009 and December 31st, 2011. A total of 1025 AMI patients with diabetes with chronic kidney disease were selected as the study cohort. The study evaluated the cardiovascular safety and efficacy of sitagliptin by comparing 205 subjects (20%) who use sitagliptin to 820 matched subjects (80%) who do not. The primary outcomes included myocardial infarction, ischemic stroke or cardiovascular death.
Primary composite outcomes occurred in 54 patients in the sitagliptin group (26.3%) and in 164 patients in the comparison group (20.0%) (HR, 1.32; 95% CI, 0.97-1.79; P=0.079) during the mean follow-up of 1.02years (SD=0.71years). The sitagliptin group had similar risks of ischemic stroke, all-cause mortality or hospitalization for heart failure (HF) compared to the non-sitagliptin group (P=0.938, 0.523 and 0.795 respectively). However, sitagliptin use was associated with increased risks of recurrent myocardial infarction (HR, 1.73; 95% CI, 1.15-2.58; P=0.008) and percutaneous coronary revascularization (HR, 1.43; 95% CI, 1.04-1.95; P=0.026).
Among type 2 diabetic patients with CKD after AMI, the use of sitagliptin was not associated with an increased risk of cardiovascular death, ischemic stroke or hospitalization for HF but was associated with increased risks of recurrent MI and percutaneous coronary revascularization.
二肽基肽酶4（DPP-4）抑制剂西格列汀在急性心肌梗死（AMI）后患有慢性肾脏病（CKD）的2型糖尿病患者中的心血管安全性和疗效尚不清楚。
我们分析了2009年3月1日至2011年12月31日台湾国民健康保险研究数据库中的数据。总共1025例患有糖尿病和慢性肾脏病的AMI患者被选为研究队列。该研究通过比较205名使用西格列汀的受试者（20%）和820名匹配的未使用西格列汀的受试者（80%）来评估西格列汀的心血管安全性和疗效。主要结局包括心肌梗死、缺血性中风或心血管死亡。
在平均1.02年（标准差=0.71年）的随访期间，西格列汀组有54例患者（26.3%）发生主要复合结局，而对照组有164例患者（20.0%）发生（风险比[HR]，1.32；95%置信区间[CI]，0.97-1.79；P=0.079）。与未使用西格列汀组相比，西格列汀组发生缺血性中风、全因死亡率或因心力衰竭（HF）住院的风险相似（P分别为0.938、0.523和0.795）。然而，使用西格列汀与复发性心肌梗死风险增加（HR，1.73；95%CI，1.15-2.58；P=0.008）和经皮冠状动脉血运重建风险增加（HR，1.43；95%CI，1.04-1.95；P=0.026）相关。
在AMI后患有CKD的2型糖尿病患者中，使用西格列汀与心血管死亡、缺血性中风或因HF住院风险增加无关，但与复发性心肌梗死和经皮冠状动脉血运重建风险增加有关。
