Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Department of Cardiology, Malazgirt State Hospital, Mus, Turkey.
Kardiol Pol. 2024;82(1):29-36. doi: 10.33963/v.kp.98260. Epub 2024 Jan 17.
It has been demonstrated that there is a significant reduction in the incidence of cardiovascular events, mortality rates, and worsening kidney disease in patients using sodium-glucose cotransporter 2 inhibitors (SGLT2i). However, there is limited information about the effect of SGLT2i on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients undergoing primary percutaneous intervention (pPCI).
Our research was focused on examining how SGLT2i exposure impacts CI-AKI occurrence in patients with ST-segment elevation myocardial infarction (STEMI) and undergoing pPCI.
This retrospective, single-center, case-control study included diabetic patients diagnosed with STEMI who underwent pPCI in a tertiary healthcare center between 2021 and 2022. The study population included SGLT2i users (n = 130) and non-SGLT2i users (n = 165). Inverse probability propensity score weighting and doubly robust estimation were performed to decrease bias and to balance covariate distribution for estimating average treatment for those treated. In a doubly robust inverse probability weighted regression model, in which covariates were balanced, CI-AKI risk was also found to be lower in the SGLT2i-user group (OR: 0.86 [0.76-0.98]; 95% CI; P = 0.028). In addition, ejection fraction, admission creatinine, albumin, and volume of contrast media were found to be independent predictors of CI-AKI in patients presenting with STEMI and undergoing pPCI.
Our study provides evidence supporting the potential protective effect of SGLT2i against CI-AKI in diabetic patients presenting with STEMI and undergoing pPCI.
已有研究表明，钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）可显著降低心血管事件发生率、死亡率和肾脏疾病恶化。然而，关于 SGLT2i 对行直接经皮冠状动脉介入治疗（pPCI）的患者对比剂诱导的急性肾损伤（CI-AKI）发生率的影响，相关信息有限。
本研究旨在探讨 SGLT2i 暴露对 ST 段抬高型心肌梗死（STEMI）并接受 pPCI 的患者 CI-AKI 发生的影响。
这是一项回顾性、单中心、病例对照研究，纳入了 2021 年至 2022 年在一家三级医疗中心接受 pPCI 的诊断为 STEMI 的糖尿病患者。研究人群包括 SGLT2i 使用者（n=130）和非 SGLT2i 使用者（n=165）。采用逆概率倾向评分加权和双重稳健估计来减少偏差，并平衡协变量分布，以估计对接受治疗的患者的平均治疗效果。在双重稳健逆概率加权回归模型中，当平衡了协变量后，SGLT2i 使用者组的 CI-AKI 风险也较低（OR：0.86[0.76-0.98]；95%CI；P=0.028）。此外，射血分数、入院肌酐、白蛋白和对比剂用量被发现是 STEMI 患者行 pPCI 后发生 CI-AKI 的独立预测因素。
本研究提供了证据支持 SGLT2i 对行 pPCI 的 STEMI 合并糖尿病患者发生 CI-AKI 的潜在保护作用。
