. 2023 Sep 30;22(1):269.

doi: 10.1186/s12933-023-02000-5.

Timing of SGLT2i initiation after acute myocardial infarction

Dirk von Lewinski¹, Ewald Kolesnik², Faisal Aziz^{3

4}, Martin Benedikt², Norbert J Tripolt^{3

4}, Markus Wallner², Peter N Pferschy^{3

4}, Friederike von Lewinski^{3

4}, Nora Schwegel², Rury R Holman⁵, Abderrahim Oulhaj⁶, Deddo Moertl^{7

8}, Jolanta Siller-Matula⁹, Harald Sourij^{4

10}

Affiliations

¹ Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. dirk.von-lewinski@medunigraz.at.
² Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
³ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
⁴ Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
⁵ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
⁶ Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE.
⁷ Karl Landsteiner University of Health Sciences, 3050, Krems, Austria.
⁸ Department of Internal Medicine 3, University Hospital St. Poelten, 3100, St. Poelten, Austria.
⁹ Department of Cardiology, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.

PMID: 37777743
PMCID: PMC10544140
DOI: 10.1186/s12933-023-02000-5

Timing of SGLT2i initiation after acute myocardial infarction

Dirk von Lewinski et al. Cardiovasc Diabetol. 2023.

. 2023 Sep 30;22(1):269.

doi: 10.1186/s12933-023-02000-5.

Authors

Affiliations

¹ Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. dirk.von-lewinski@medunigraz.at.
² Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
³ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
⁴ Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
⁵ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
⁶ Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE.
⁷ Karl Landsteiner University of Health Sciences, 3050, Krems, Austria.
⁸ Department of Internal Medicine 3, University Hospital St. Poelten, 3100, St. Poelten, Austria.
⁹ Department of Cardiology, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.

PMID: 37777743
PMCID: PMC10544140
DOI: 10.1186/s12933-023-02000-5

Abstract

Background: Pharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered "sick days drugs" and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation.

Methods and results: The EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: - 69.1; - 48.1) in the early group compared to 61.0% (- 76.0; - 41.4) in the intermediate and 61.9% (- 70.8; - 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups-initiation time interaction (p_int = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected.

Conclusion: Very early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2-3 days.

Trial registration: ClinicalTrials.gov NCT03087773.

Keywords: Clinical trial; Myocardial infarction; SGLT2i; Timing.

PubMed Disclaimer

Conflict of interest statement

H.S. is on the advisory board and speakers bureau of by Boehringer Ingelheim, NovoNordisk, Sanofi-Aventis, Amgen, AstraZeneca, Bayer, Eli Lilly, Kapsch, MSD, and Daiichi Sankyo. D.V.L. is on the advisory board and speakers’ bureau of Abiomed, AstraZeneca, Bayer, Daiichi Sankyo, Orion, Sanofi, and Servier and receives consulting fees from Recardio Inc, Bayer, TLL, Vaxxinity Inc. R.R.H. reports research support from AstraZeneca, Bayer and Merck Sharp & Dohme, and personal fees from Anji Pharmaceuticals, AstraZeneca, Novartis, and Novo Nordisk. M.W. receives speaker fees from Bayer, Novartis and consulting fees from Radcliff Cardiology. J.M.S.M. received speaker or consultant fees from Chiesi, Boehringer Ingelheim, Biosensors, P&F, Gruenenthal, Bayer, Medtronic, and Boston Scientific within the last 3 years. D.M. receives consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, and Vifor, further he receives payment for lectures from AstraZeneca, Bayer, Boehringer Ingelheim, Vifor, and BMS. The remaining authors have no relevant conflict of interest.

Figures

**Fig. 1**
(A) Mean±SEM change in LV-EF (left ventricular ejection fraction; %) and (B) e/e`(measure of diastolic function) over time

**Fig. 2**
(A) Mean±SEM change in left ventricular end systolic volume (LVESD, mm) and (B) left ventricular end diastolic volume (LVEDV, mm) over time

See this image and copyright information in PMC

References

1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Socie. Eur Heart J. 2018;39(2):119–177. doi: 10.1093/eurheartj/ehx393. - DOI - PubMed
1. Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, et al. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995–2006. JAMA. 2009;302(7):767–773. doi: 10.1001/jama.2009.1178. - DOI - PMC - PubMed
1. Ibanez B, Macaya C, Sánchez-Brunete V, Pizarro G, Fernández-Friera L, Mateos A, et al. Effect of early metoprolol on infarct size in ST-segment–elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Circulation. 2013;128(14):1495–1503. doi: 10.1161/CIRCULATIONAHA.113.003653. - DOI - PubMed
1. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–1367. doi: 10.1093/eurheartj/ehaa575. - DOI - PubMed
1. von Lewinski D, Kolesnik E, Tripolt NJ, Pferschy PN, Benedikt M, Wallner M, et al. Empagliflozin in acute myocardial infarction: the EMMY trial. Eur Heart J. 2022;43(41):4421–4432. doi: 10.1093/eurheartj/ehac494. - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Timing of SGLT2i initiation after acute myocardial infarction

Affiliations

Timing of SGLT2i initiation after acute myocardial infarction

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous