Department of Cardiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, 213000, People's Republic of China.
Department of Gastroenterology Centre, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, 213000, People's Republic of China.
Cardiovasc Diabetol. 2022 Sep 16;21(1):186. doi: 10.1186/s12933-022-01627-0.
The effect of dapagliflozin (DAPA) on the prognosis of patients with acute myocardial infarction (AMI) is unclear. The present study was conducted to evaluate the association between DAPA administration and adverse events in patients with AMI undergoing percutaneous coronary intervention (PCI).
This single-center retrospective analysis study included a total of 786 patients with AMI from January 2019 to August 2021 who were or were not administered DAPA at discharge. The primary endpoint was the composite of major adverse cardiovascular events (MACE), including overall deaths, heart failure, nonfatal MI, nonfatal stroke, and unplanned repeat revascularization (URR). Differences in the triglyceride glucose (TyG) index and the atherogenic index of plasma (AIP) both during hospitalization and 12 months after discharge (if achievable) were also compared.
During a median follow-up of 23 months, 130 patients had MACE (118 in the DAPA-free group and 12 in the DAPA group). Kaplan-Meier survival analyses revealed that the cumulative incidence of MACE (log-rank test, p = 0.009), heart failure (p = 0.003), nonfatal MI (p = 0.005), and URR (p = 0.031) was higher in the DAPA-free group. In addition, the multivariate Cox analysis showed that DAPA was significantly associated with the reduced risk of MACE (hazard ratio = 0.170, 95% confidence interval = 0.078-0.373, p < 0.001). Considering each specific adverse event, the DAPA-free group was associated with heart failure, nonfatal MI, and URR in multivariate Cox regression analyses. Stratification analyses suggested that DAPA has a strong protective effect in patients with AMI of advanced age with concomitant diabetes or those who are not on angiotensin receptor enkephalinase inhibitors. Furthermore, the TyG index and AIP of the patients 12 months after DAPA administration at discharge were significantly lower than those during hospitalization.
DAPA is an independent protective factor against MACE and may provide incremental prognostic information in patients with AMI undergoing PCI.
达格列净（DAPA）对急性心肌梗死（AMI）患者预后的影响尚不清楚。本研究旨在评估 AMI 患者行经皮冠状动脉介入治疗（PCI）后应用达格列净与不良事件之间的关系。
本单中心回顾性分析研究纳入了 2019 年 1 月至 2021 年 8 月期间共 786 名 AMI 患者，根据出院时是否应用达格列净分为达格列净组和非达格列净组。主要终点为主要不良心血管事件（MACE）的复合终点，包括全因死亡、心力衰竭、非致死性心肌梗死、非致死性卒中和计划性再次血运重建（URR）。还比较了住院期间和出院后 12 个月（如果可行）的甘油三酯-葡萄糖（TyG）指数和血浆致动脉粥样硬化指数（AIP）的差异。
中位随访 23 个月期间，130 名患者发生了 MACE（非达格列净组 118 例，达格列净组 12 例）。Kaplan-Meier 生存分析显示，非达格列净组的 MACE（log-rank 检验，p=0.009）、心力衰竭（p=0.003）、非致死性心肌梗死（p=0.005）和 URR（p=0.031）的累积发生率更高。此外，多变量 Cox 分析显示，达格列净与 MACE 风险降低显著相关（风险比=0.170，95%置信区间=0.078-0.373，p<0.001）。考虑到每种具体的不良事件，多变量 Cox 回归分析显示非达格列净组与心力衰竭、非致死性心肌梗死和 URR 相关。分层分析提示，在年龄较大合并糖尿病或未应用血管紧张素受体脑啡肽酶抑制剂的 AMI 患者、或出院时应用达格列净的 AMI 患者中，达格列净具有很强的保护作用。此外，出院时应用达格列净后 12 个月患者的 TyG 指数和 AIP 明显低于住院期间。
达格列净是 AMI 患者 PCI 后 MACE 的独立保护因素，并可能为 AMI 患者提供额外的预后信息。
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