钠-葡萄糖协同转运蛋白2抑制剂对糖尿病急性心肌梗死患者左心室重构的影响

Impact of SGLT2 Inhibitors on Left Ventricular Remodeling in Diabetic Patients with Acute Myocardial Infarction.

作者信息

Wan Jun, Xu Feng, Zuo Heping, Jiang Xin, Wang Yulin, Jiang Yang, Chen Cai, Yin Chunlin, Cheng Jinglin, Li He

机构信息

Department of Emergency Internal Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.

Department of Electrocardiographic Diagnosis, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.

出版信息

J Cardiovasc Pharmacol Ther. 2024 Jan-Dec;29:10742484241301191. doi: 10.1177/10742484241301191.

DOI:10.1177/10742484241301191

PMID:39639712

Abstract

OBJECTIVE

To assess the effect of sodium-glucose cotransporter 2 inhibitors (SGLT2-I) on cardiac remodeling and prognosis in type 2 diabetes mellitus (T2DM) patients presenting with acute myocardial infarction (AMI).

METHODS

In this single-center retrospective active-comparator study, consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2021 and 2023 were enrolled. Patients were divided into SGLT2-I users and non-SGLT2-I users based on discharge medications. The primary endpoint was the left ventricular remodeling index (LVRI), defined as the relative change in LV end-diastolic volume after six months. The secondary outcomes included major adverse cardiovascular events (MACE), comprising all-cause mortality, hospitalization for heart failure, nonfatal MI, and nonfatal stroke.

RESULTS

The study comprised 423 T2DM AMI patients(with or without ST-segment elevation), with 239 SGLT2-I users and 184 non-SGLT2-I users. At six months, LVRI was significantly lower in the SGLT2-I users compared to the non-SGLT2-I users (3.49 ± 19.71 vs 7.06 ± 15.15, = .042). The non-SGLT2-I users exhibited a higher prevalence of positive LVR (LVRI > 0%) (64.67% vs 50.63%, = .004) and pathological LVR (LVRI > 20%) (19.57% vs 12.13%, = .036). Multivariate logistic regression indicated that SGLT2-I was associated with a reduced risk of LVR (OR 0.6; 95%CI 0.38-0.97; = .035). During a mean follow-up of 25 ± 8 months, Kaplan-Meier analysis demonstrated a lower rate of MACE-free survival in the non-SGLT2-I users ( = .005).

CONCLUSIONS

SGLT2-I protects against LVR and lowers the risk of adverse cardiovascular outcomes in T2DM AMI patients.

摘要

目的

评估钠-葡萄糖协同转运蛋白2抑制剂（SGLT2-I）对2型糖尿病（T2DM）合并急性心肌梗死（AMI）患者心脏重塑及预后的影响。

方法

在这项单中心回顾性活性对照研究中，纳入了2021年至2023年间接受经皮冠状动脉介入治疗（PCI）的连续性糖尿病AMI患者。根据出院用药情况将患者分为SGLT2-I使用者和非SGLT2-I使用者。主要终点是左心室重塑指数（LVRI），定义为六个月后左心室舒张末期容积的相对变化。次要结局包括主要不良心血管事件（MACE），包括全因死亡率、因心力衰竭住院、非致命性心肌梗死和非致命性卒中。

结果

该研究纳入了423例T2DM合并AMI患者（伴或不伴ST段抬高），其中SGLT2-I使用者239例，非SGLT2-I使用者184例。六个月时，SGLT2-I使用者的LVRI显著低于非SGLT2-I使用者（3.49±19.71 vs 7.06±15.15, P = 0.042）。非SGLT2-I使用者的左心室重塑阳性（LVRI>0%）患病率更高（64.67% vs 50.63%, P = 0.004），病理性左心室重塑（LVRI>20%）患病率也更高（19.57% vs 12.13%, P = 0.036）。多因素逻辑回归表明，SGLT2-I与左心室重塑风险降低相关（OR 0.6；95%CI 0.38-0.97；P = 0.035）。在平均25±8个月的随访期间，Kaplan-Meier分析显示非SGLT2-I使用者无MACE生存的发生率较低（P = 0.005）。