SGLT2-inhibition and myocardial infarction size in patients with type 2 diabetes mellitus- Insights from an acute cardiovascular care center

Abstract

Aims: This study aimed to assess the association between myocardial infarction (MI) size and clinical outcome with ongoing Sodium-glucose-cotransporter-2 inhibitor (SGLT2-i) use.

Methods and results: In this retrospective single-center cohort study 681 patients with MI and diabetes mellitus type 2 (T2DM) treated with percutaneous coronary intervention (PCI) between November 2015 and December 2023 were included. 105 patients received ongoing SGLT2-i therapy and 576 were taking other glucose-lowering medication at the time of admission. The primary outcome was the size of MI. MI size was determined by the peak high-sensitive troponinT (hs-TnT x ULN [upper limit of normal]) normalized on the endangered myocardial area (EMA). No significant statistical differences were observed in hs-TnT values (hsTnT x ULN: 55 [13-174] vs. 68 [22-182]; p = 0.36) and EMA (41 [29-59] vs. 35 [24-59] %; p = 0.24) between patients with and without SGLT2-i therapy. After augmented inverse-probability weighted analyses, ongoing SGLT2-i therapy was not significantly associated with a reduced MI size (difference between means hsTnT x ULN/EMA [1/%]: - 0.24 [95% confidence interval, - 2.95 to 2.48]; p = 0.54). Secondary outcomes were in-hospital major adverse events and length of intensive care unit (ICU) treatment. SGLT2-i use was not associated with fewer in-hospital adverse events (3.81, vs. 4.17% [95% CI, - 2.95 to 2.48], p = 0.94) or with fewer days on ICU (1 [1-1] vs. 1 [1-2] days, p = 0.78).

Conclusion: In this retrospective cohort study of T2DM patients presenting with MI, prior prescription of SGLT2-i was not associated with reduced MI size or fewer adverse events during hospitalization for MI treated with PCI.

Trial registration number and date: DRKS00032432 (Registration Date: 07 August 2023).

Keywords: Acute myocardial infarction; Diabetes mellitus.; Infarct size; SGLT2-inhibitors.

Fig. 1

Screening flow chart

Fig. 2

Myocardial infarction area differences between the SGLT2-i use and non-SGLT2-i use groups. Myocardial infarction area was calculated based on the coronary angiogram and maximum hs-TnT values as described in the methods section. *P-value after inverse probability weighting approach

Fig. 3

Three-year survival was analyzed using pseudo-observations and linear regression with application of the method by Overgaard, Anderson and Parmer. The overall three-year incidence of death was 25.8% and SGLT2-i therapy reduced this significantly (Log-rank test: p = 0.035), which, however, did not reach statistical significance after using the augmented inverse probability weighting approach (p = 0.926). *p-value after inverse probability weighting approach