Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
Cardiovasc Diabetol. 2023 Sep 30;22(1):269. doi: 10.1186/s12933-023-02000-5.
Pharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered "sick days drugs" and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation.
The EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: - 69.1; - 48.1) in the early group compared to 61.0% (- 76.0; - 41.4) in the intermediate and 61.9% (- 70.8; - 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups-initiation time interaction (p = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected.
Very early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2-3 days.
药物治疗通常在重症监护病房/心脏护理病房开始进行。然而，只有双联抗血小板治疗和他汀类药物的早期治疗有确凿的证据，而β受体阻滞剂和 RAAS 抑制剂的数据则存在差异，主要限于 ST 段抬高型心肌梗死和心力衰竭患者。最近，EMMY 试验首次提供了在 PCI 后早期开始 SGLT2 抑制剂（SGLT2i）有益效果的证据。在 2 型糖尿病患者中，SGLT2i 被认为是“病假药物”，因此，MI 后非常早期开始 SGLT2i 是否与延迟开始一样安全有效仍不清楚。
EMMY 试验评估了恩格列净对 NT-proBNP 以及功能和结构测量的影响。在恩格列净组中，22 例（9.5%）在 PCI 后<24 小时内接受早期治疗，98 例（42.2%）在 24 至<48 小时的窗口内接受治疗（中间），111 例（48.1%）在 48 至 72 小时内接受治疗（晚期）。与中间组（-76.0；-41.4）和晚期组（-70.8；-45.7）相比，早期组 NT-proBNP 水平下降 63.5%（95%CI：-69.1；-48.1），恩格列净组无显著的治疗组-起始时间相互作用（p=0.96）。左心室功能（LV-EF，e/e`）和结构（LVESD 和 LVEDD）的次要终点在各组之间也相似。在起始时间组之间未检测到严重不良事件发生率的显著差异。
急性心肌梗死后非常早期使用 SGLT2i 不会显示出安全性的不利信号，并且在降低 NT-proBNP 以及改善结构和功能 LV 标志物方面似乎与 2-3 天后开始治疗一样有效。
Zotero 插件