Peikert Alexander, Vaduganathan Muthiah, Claggett Brian L, Kulac Ian J, Foà Alberto, Desai Akshay S, Jhund Pardeep S, Carberry Jaclyn, Lam Carolyn S P, Kosiborod Mikhail N, Inzucchi Silvio E, Martinez Felipe A, de Boer Rudolf A, Hernandez Adrian F, Shah Sanjiv J, Køber Lars, Ponikowski Piotr, Sabatine Marc S, Petersson Magnus, Langkilde Anna Maria, McMurray John J V, Solomon Scott D
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria.
Eur J Heart Fail. 2024 Apr;26(4):912-924. doi: 10.1002/ejhf.3184. Epub 2024 Mar 15.
Patients with heart failure (HF) and history of myocardial infarction (MI) face a higher risk of disease progression and clinical events. Whether sodium-glucose cotransporter 2 inhibitors may modify clinical trajectory in such individuals remains incompletely understood.
The DAPA-HF and DELIVER trials compared dapagliflozin with placebo in patients with symptomatic HF with left ventricular ejection fraction (LVEF) ≤40% and > 40%, respectively. In this pooled participant-level analysis, we assessed efficacy and safety outcomes by history of MI. The primary outcome in both trials was the composite of cardiovascular death or worsening HF. Of the total of 11 007 patients, 3731 (34%) had a previous MI and were at higher risk of the primary outcome across the spectrum of LVEF in covariate-adjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02-1.24). Dapagliflozin reduced the risk of the primary outcome to a similar extent in patients with (HR 0.83, 95% CI 0.72-0.96) and without previous MI (HR 0.76, 95% CI 0.68-0.85; p = 0.36), with consistent benefits on key secondary outcomes as well. Serious adverse events did not occur more frequently with dapagliflozin, irrespective of previous MI.
History of MI confers increased risks of adverse cardiovascular outcomes in patients with HF across the LVEF spectrum, even among those with preserved ejection fraction. Dapagliflozin consistently and safely reduces the risk of cardiovascular death or worsening HF, regardless of previous MI.
心力衰竭（HF）且有心肌梗死（MI）病史的患者面临更高的疾病进展和临床事件风险。钠-葡萄糖协同转运蛋白2抑制剂是否能改变这类患者的临床病程仍未完全明确。
DAPA-HF试验和DELIVER试验分别在左心室射血分数（LVEF）≤40%和>40%的有症状HF患者中比较了达格列净与安慰剂。在这项汇总的个体水平分析中，我们根据MI病史评估了疗效和安全性结局。两项试验的主要结局均为心血管死亡或HF恶化的复合结局。在总共11007例患者中，3731例（34%）曾有MI，在协变量调整模型中，在整个LVEF范围内发生主要结局的风险更高（风险比[HR]1.12，95%置信区间[CI]1.02-1.24）。达格列净在有（HR 0.83，95%CI 0.72-0.96）和无MI病史（HR 0.76，95%CI 0.68-0.85；p = 0.36）的患者中降低主要结局风险的程度相似，对关键次要结局也有一致的益处。无论有无MI病史，达格列净导致严重不良事件的发生频率均未增加。
MI病史会增加整个LVEF范围内HF患者发生不良心血管结局的风险，即使是射血分数保留的患者。无论有无MI病史，达格列净均能持续且安全地降低心血管死亡或HF恶化的风险。
