Haloot Justin, Krokar Lucijana, Badin Auroa
University of Texas Health San Antonio, San Antonio, TX.
J Atr Fibrillation. 2021 Aug 31;14(2):20200502. doi: 10.4022/jafib.20200502. eCollection 2021 Aug.
Sodium glucose cotransporter 2 (SGLT2) inhibitors have been associated with various cardiovascular benefits. There is limited data examining the effect of these medications on atrial fibrillation (AF) associated clinical outcomes. We compared ischemic stroke, acute coronary syndrome (ACS), cardioversion, and all-cause mortality outcomes in AF patients on SGLT2 inhibitors to propensity matched controls.
We conducted a retrospective study with a global medical research network database. AF patients were identified via ICD codes that must have been present for at least one month. Patients on SGLT2 inhibitors were identified as those on dapagliflozin, empagliflozin, or canagliflozin for at least one month. AF patients on SGLT2 inhibitors were propensity matched to those not on SGLT2 inhibitors based on age, race, ethnicity, cardiovascular comorbidities, valvular disease, pulmonary disease, urinary diseases, cardiovascular procedures, cardiovascular medications, and anticoagulants. We examined incidence of ischemic stroke, at least one ACS episode, cardioversion, and all-cause mortality.
In 26,269 AF patients, SGLT2 inhibitors were associated with lower risk of cardioversion (HR 0.921, 95% CI 0.841 - 0.999, p = 0.0245) and all-cause mortality (HR 0.676, 95% CI 0.635 - 0.721, p < 0.0001). However, there was an association with increased risk for ischemic stroke (HR 1.081, 95% CI 1.012 - 1.154, p 0.0201). There was no clear association with ACS events.
In patients with AF, use of SGLT2 inhibitors was associated with a lower risk of cardioversion and all-cause mortality and higher probability of survival based on Kaplan-Meier analysis.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已显示出多种心血管益处。关于这些药物对心房颤动（AF）相关临床结局影响的数据有限。我们比较了使用SGLT2抑制剂的AF患者与倾向匹配对照组在缺血性卒中、急性冠状动脉综合征（ACS）、心脏复律和全因死亡率方面的结局。
我们利用一个全球医学研究网络数据库进行了一项回顾性研究。通过国际疾病分类（ICD）编码识别AF患者，这些编码必须存在至少一个月。使用SGLT2抑制剂的患者被确定为使用达格列净、恩格列净或卡格列净至少一个月的患者。根据年龄、种族、民族、心血管合并症、瓣膜病、肺病、泌尿系统疾病、心血管手术、心血管药物和抗凝剂，将使用SGLT2抑制剂的AF患者与未使用SGLT2抑制剂的患者进行倾向匹配。我们研究了缺血性卒中的发生率、至少一次ACS发作、心脏复律和全因死亡率。
在26269例AF患者中，SGLT2抑制剂与较低的心脏复律风险（风险比[HR]0.921，95%置信区间[CI]0.841 - 0.999，p = 0.0245）和全因死亡率（HR 0.676，95% CI 0.635 - 0.721，p < 0.0001）相关。然而，与缺血性卒中风险增加相关（HR 1.081，95% CI 1.012 - 1.154，p = 0.0201）。与ACS事件无明显关联。
在AF患者中，基于Kaplan-Meier分析，使用SGLT2抑制剂与较低的心脏复律风险和全因死亡率以及较高的生存概率相关。
