Yu Jie, Li Jingwei, Leaver Phillip J, Arnott Clare, Huffman Mark D, Udell Jacob A, Perkovic Vlado, Mahaffey Kenneth W, de Zeeuw Dick, Fulcher Greg, Matthews David R, Shaw Wayne, Rosenthal Norman, Neal Bruce, Figtree Gemma A
The George Institute for Global Health, UNSW Sydney, Level 5, 1 King Street, Newtown, 2042 Sydney, Australia.
Department of Cardiology, Peking University Third Hospital, Level 5, 1 King Street, Newtown, 2042 Beijing, China.
Cardiovasc Res. 2022 Mar 16;118(4):1103-1114. doi: 10.1093/cvr/cvab128.
Given the benefits of sodium glucose co-transporter 2 inhibition (SGLT2i) in protecting against heart failure in diabetic patients, we sought to explore the potential impact of SGLT2i on the clinical features of patients presenting with myocardial infarction (MI) through a post hoc analysis of CANVAS Programme and CREDENCE trial.
Individuals with type 2 diabetes and history or high risk of cardiovascular disease (CANVAS Programme) or type 2 diabetes and chronic kidney disease (CREDENCE) were included. The intervention was canagliflozin 100 or 300 mg (combined in the analysis) or placebo. MI events were adjudicated as ST-elevation myocardial infarction (STEMI), non-STEMI, and type 1 MI or type 2 MI. A total of 421 first MI events in the CANVAS Programme and 178 first MI events in the CREDENCE trial were recorded (83 fatal, 128 STEMI, 431 non-STEMI, and 40 unknown). No benefit of canagliflozin compared with placebo on time to first MI event was observed [hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.75, 1.05]. Canagliflozin was associated with lower risk for non-STEMI (HR 0.78; 95% CI 0.65, 0.95) but suggested a possible increase in STEMI (HR 1.55; 95% CI 1.06, 2.27), with no difference in risk of type 1 or type 2 MI. There was no change in fatal MI (HR 1.22, 95% CI 0.78, 1.93).
Canagliflozin was not associated with a reduction in overall MI in the pooled CANVAS Programme and CREDENCE trial population. The possible differential effect on STEMI and Non-STEMI observed in the CANVAS cohort warrants further investigation.
ClinicalTrials.gov identifiers: NCT01032629, NCT01989754, and NCT02065791.
鉴于钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在预防糖尿病患者心力衰竭方面的益处，我们试图通过对CANVAS研究项目和CREDENCE试验进行事后分析，探讨SGLT2i对心肌梗死（MI）患者临床特征的潜在影响。
纳入患有2型糖尿病且有心血管疾病病史或高风险（CANVAS研究项目）或2型糖尿病和慢性肾脏病（CREDENCE）的个体。干预措施为卡格列净100或300mg（分析中合并）或安慰剂。MI事件被判定为ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）以及1型MI或2型MI。CANVAS研究项目中共记录了421例首次MI事件，CREDENCE试验中共记录了178例首次MI事件（83例死亡，128例STEMI，431例NSTEMI，40例情况不明）。与安慰剂相比，未观察到卡格列净在首次MI事件发生时间方面有获益[风险比（HR）0.89；95%置信区间（CI）0.75，1.05]。卡格列净与较低的NSTEMI风险相关（HR 0.78；95% CI 0.65，0.95），但提示STEMI风险可能增加（HR 1.55；95% CI 1.06，2.27），1型或2型MI风险无差异。致命性MI无变化（HR 1.22，95% CI 0.78，1.93）。
在汇总的CANVAS研究项目和CREDENCE试验人群中，卡格列净与总体MI的减少无关。在CANVAS队列中观察到的对STEMI和NSTEMI可能的差异效应值得进一步研究。
ClinicalTrials.gov标识符：NCT01032629、NCT01989754和NCT02065791。
