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Giovanna Liuzzo, Carlo Patrono, Weekly Journal Scan: sodium/glucose cotransporter 2 inhibition after myocardial infarction still in the grey area, European Heart Journal, Volume 45, Issue 27, 14 July 2024, Pages 2360–2361, https://doi.org/10.1093/eurheartj/ehae304
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Comment on ‘Empagliflozin after Acute Myocardial Infarction’ which was published in the New England Journal of Medicine, https://doi.org//10.1056/NEJMoa2314051
Comment
Previous trials have tested the hypothesis that sodium/glucose cotransporter 2 (SGLT2) inhibition may help counteract the increased risk of HF and death after AMI, particularly in the presence of congestion and/or decreased LVEF.2,3 In the Impact of Empagliflozin on Cardiac Function and Biomarkers of Heart Failure in Patients with Acute Myocardial Infarction (EMMY) trial, patients who received empagliflozin 10 mg daily after an AMI had reduced plasma natriuretic peptide levels (the primary endpoint), increased LVEF, and a decreased cardiac volume over a 26-week follow-up; however, because of its limited sample size (n = 476) and follow-up, this trial was not designed to assess clinical outcomes.2 The Dapagliflozin Effects on Cardiometabolic Outcomes in Patients with an Acute Heart Attack (DAPA-MI) trial enrolled 4017 patients with AMI and impaired LVEF, without prior diabetes or chronic HF.3 After approximately 1 year of treatment with dapagliflozin 10 mg daily, there were significant benefits on cardiometabolic outcomes, as assessed with the win ratio analysis method, but no reduction in the composite of cardiovascular death or hospitalization for HF: this occurred in 50 of 2019 (2.5%) patients assigned to dapagliflozin and 52 of 1998 (2.6%) patients assigned to placebo (HR, 0.95; 95% CI, 0.64–1.40).3