Zhao Zinan, Zheng Naixin, Zhang Tianqi, Zhang Chi, Li Yuwei, Lan Ming, Zhang Ni, Li Hui, Ai Hu, Liu Deping
Department of Pharmacy, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, People's Republic of China.
Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Cardiovasc Diabetol. 2025 Apr 26;24(1):185. doi: 10.1186/s12933-025-02678-9.
Although sodium‒glucose cotransporter-2 (SGLT2) inhibitors have cardiorenal benefits, their efficacy in patients with type 2 diabetes mellitus (T2DM) and chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) remains underexplored.
To evaluate the cardiorenal protective effects of the SGLT2 inhibitor dapagliflozin in patients with T2DM and CCS receiving PCI.
DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional analysis of 1,430 patients from a tertiary hospital database who underwent PCI (January 1, 2018, to March 31, 2022).
Cardiac outcomes (PMI/4aMI) and renal outcomes (eGFR and CI-AKI).
After 1:1 propensity score matching (PSM) (176 dapagliflozin vs. 176 control), the dapagliflozin group showed significantly lower PMI/4aMI rates pre-PSM (39.78% vs. 66.99%; OR 0.862, 95% CI 0.823-0.904; p < 0.001) and post-PSM (39.77% vs. 60.23%; OR 0.660, 95% CI 0.531-0.821; p < 0.001), with sustained significance after adjustment (adjusted OR 0.436, 95% CI 0.285-0.668; p < 0.001). Subgroup analyses highlighted increased protection in patients aged ≥ 65 years, those with multivessel disease, and those with higher contrast volumes. Renal outcomes (CI-AKI and CI-AKI) were not significantly different before or after PSM or after adjustment (all p > 0.05).
Dapagliflozin exerted robust cardioprotective effects against PMI/4aMI in patients with T2DM and CCS undergoing PCI, particularly among patients in high-risk subgroups, but it did not significantly reduce the risk of CI-AKI. These findings support the peri-PCI use of dapagliflozin to mitigate cardiac risk while highlighting the need for further research to elucidate its renal effects in this population.
尽管钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂具有心肾保护作用，但其在接受经皮冠状动脉介入治疗（PCI）的2型糖尿病（T2DM）和慢性冠状动脉综合征（CCS）患者中的疗效仍未得到充分研究。
评估SGLT2抑制剂达格列净对接受PCI的T2DM和CCS患者的心肾保护作用。
设计、设置和参与者：这是一项对一家三级医院数据库中1430例接受PCI的患者（2018年1月1日至2022年3月31日）进行的横断面分析。
心脏结局（PMI/4aMI）和肾脏结局（估算肾小球滤过率[eGFR]和对比剂诱导的急性肾损伤[CI-AKI]）。
在1:1倾向评分匹配（PSM）后（176例达格列净组与176例对照组），达格列净组在PSM前的PMI/4aMI发生率显著更低（39.78%对66.99%；比值比[OR]0.862，95%置信区间[CI]0.823 - 0.904；p < 0.001），PSM后也更低（39.77%对60.23%；OR 0.660，95% CI 0.531 - 0.821；p < 0.001），调整后仍具有显著意义（调整后OR 0.436，95% CI 0.285 - 0.668；p < 0.001）。亚组分析强调了在年龄≥65岁、患有多支血管病变以及使用更高造影剂剂量的患者中保护作用增强。肾脏结局（CI-AKI和CI-AKI）在PSM前后或调整后均无显著差异（所有p > 0.05）。
达格列净对接受PCI的T2DM和CCS患者的PMI/4aMI具有强大的心脏保护作用，尤其是在高危亚组患者中，但它并未显著降低CI-AKI的风险。这些发现支持在PCI围手术期使用达格列净以减轻心脏风险，同时突出了进一步研究以阐明其在该人群中肾脏作用的必要性。
