Empagliflozin in Heart Failure and Previous Coronary Revascularization: Insights From EMPEROR-Pooled

Sodium glucose co-transporter-2 inhibitors are a foundational therapy for the management of chronic heart failure (HF).

The purpose of this study was to investigate whether the efficacy of sodium glucose co-transporter-2 inhibitors in patients with HF is maintained in patients with a history of coronary revascularization.

The EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure (EMPEROR)-Pooled database was a prospectively designed pooled analysis of the EMPEROR-Reduced (NCT03057977) and EMPEROR-Preserved (NCT03057951) trials, which randomized patients with HF with a left ventricular ejection fraction below and above 40%, respectively, to empagliflozin or placebo. The primary outcome was time to first HF hospitalization or cardiovascular death. We studied the baseline risk of revascularized HF patients and the impact of previous revascularization on the efficacy and safety of empagliflozin.

Overall, 3,437/9,718 (35.4%) had a history of coronary revascularization with either percutaneous coronary intervention or coronary artery bypass grafting (REVASC), and 6,281/9,718 (64.6%) did not (no REVASC). The median follow-up time was 21.23 months (IQR: 14.93-28.97 months). Of those randomized to placebo, a history of revascularization was not associated with an elevated risk of clinical outcomes, including the primary outcome and 3-point major adverse cardiac and cerebrovascular event. The efficacy and safety of empagliflozin were consistent irrespective of revascularization history for all major outcomes (primary outcome: REVASC: 0.76 [0.66-0.89], no REVASC: 0.77 [0.68-0.87], P_interaction: 0.94). Empagliflozin had neutral effect on a 3-point major adverse cardiac and cerebrovascular event in both groups.

In this large HF trial program, revascularized patients with HF exhibited similar rates of HF and ischemic events as those without prior revascularization. The efficacy and safety of empagliflozin in HF were consistent in those with and without a revascularization history.