Quisi Alaa, Nacar Quisi Nur Selin, Alıcı Gökhan, Donma İdil, Yıldırım Abdullah, Genç Ömer
Department of Cardiology, Medline Adana Hospital, Adana, Turkey.
Department of Cardiology, Çukurova University Faculty of Medicine, Adana, Turkey.
Acta Cardiol. 2025 Jun;80(4):394-402. doi: 10.1080/00015385.2025.2500892. Epub 2025 May 14.
This study aimed to assess the effect of dapagliflozin on the no-reflow phenomenon in patients with type II diabetes mellitus (T2DM) and acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI).
This single-center, observational cohort study included a total of 829 consecutive T2DM patients who were diagnosed with AMI and underwent PCI within 24 h of the onset of symptoms. Only patients using dapagliflozin (10 mg per day) for more than one year were considered as patients using dapagliflozin. The no-reflow phenomenon was defined as inadequate myocardial perfusion within a segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction, dissection, or residual stenosis after PCI.
Four hundred and thirty-four patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), and 395 patients were diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Forward conditional logistic regression analysis demonstrated that the estimated glomerular filtration rate (OR = 0.940, 95% CI: 0.900 to 0.982, = 0.006), SYNTAX score I (OR = 1.338, 95% CI: 1.179 to 1.520, < 0.001), and dapagliflozin use (OR = 0.030, 95% CI: 0.004 to 0.228, = 0.001) were independent predictors of the no-reflow phenomenon in STEMI. However, dapagliflozin use (OR = 0.112, 95% CI: 0.013 to 0.933, = 0.043) was the only independent predictor of the no-reflow phenomenon in NSTEMI.
Lower rates of the no-reflow phenomenon were observed in T2DM patients taking dapagliflozin, diagnosed with AMI, and underwent PCI. However, this finding requires further investigation.
本研究旨在评估达格列净对接受经皮冠状动脉介入治疗（PCI）的2型糖尿病（T2DM）合并急性心肌梗死（AMI）患者无复流现象的影响。
本单中心观察性队列研究共纳入829例连续的T2DM患者，这些患者被诊断为AMI且在症状发作后24小时内接受了PCI。仅将使用达格列净（每日10毫克）超过一年的患者视为使用达格列净的患者。无复流现象定义为冠状动脉循环某节段心肌灌注不足，且PCI后无机械性血管阻塞、夹层或残余狭窄的血管造影证据。
434例患者被诊断为ST段抬高型心肌梗死（STEMI），395例患者被诊断为非ST段抬高型心肌梗死（NSTEMI）。向前条件逻辑回归分析表明，估计肾小球滤过率（OR = 0.940，95%CI：0.900至0.982，P = 0.006）、SYNTAX评分I（OR = 1.338，95%CI：1.179至1.520，P < 0.001）和使用达格列净（OR = 0.030，95%CI：0.004至0.228，P = 0.001）是STEMI患者无复流现象的独立预测因素。然而，使用达格列净（OR = 0.112，95%CI：0.013至0.933，P = 0.043）是NSTEMI患者无复流现象的唯一独立预测因素。
在诊断为AMI并接受PCI的T2DM患者中，使用达格列净的患者无复流现象发生率较低。然而，这一发现需要进一步研究。
