Related Experiment Videos
Dapagliflozin in acute myocardial infarction with type 2 diabetes: a randomized clinical trial
Hilda Elizabeth Macías-Cervantes1, Rodolfo Guardado-Mendoza2, Luis Jonathan González3
1Internal Medicine Department, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social, Blvd. Adolfo López Mateos esquina Insurgentes S/N, colonia Los Paraísos, 37260, León, Guanajuato, México.
Introduction And Objectives:
Dapagliflozin does not impact heart failure events in patients with myocardial infarction who do not have type 2 diabetes. However, its effects on patients with diabetes remain unexamined. Therefore, the main goal of this study was to assess the effect of dapagliflozin added to post-acute myocardial infarction (AMI) therapy on the occurrence of major adverse cardiovascular events (MACE), including heart failure (HF), cardiovascular death, stroke, and new acute myocardial infarction in patients with type 2 diabetes. Secondary endpoints included changes in left ventricular ejection fraction (LVEF).
Methods:
In a double-blind controlled clinical trial with an 18-month follow-up, we randomly assigned 181 patients with AMI to receive 10 mg of dapagliflozin or placebo once daily, along with standardized management. Risk analysis was conducted using both intention-to-treat and per-protocol analyses.
Results:
At the 18-month follow-up, the total number of heart failure events was higher in the placebo group (26 events; 29.5%) than in the dapagliflozin group (5 events; 5.3%) (HR 0.18; 95% CI, 0.40-0.85; p < 0.001). Final LVEF increased by 1.56% in the dapagliflozin group compared to placebo (p = 0.03).
Conclusions:
Early initiation of dapagliflozin as part of the standard treatment for patients with acute myocardial infarction and type 2 diabetes decreases the risk of heart failure events at 18 months, improves LVEF, and remains safe even when combined with current optimal medical therapy. (ClinicalTrials.gov NCT04717986).
Related Concept Videos
Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
Dipeptidyl Peptidase 4 Inhibitors
Type I Diabetes III: Clinical Manifestations
Type II Diabetes II: Pathophysiology
Diabetes Mellitus: Type 2 and Gestational
Oral Hypoglycemic Agents: Biguanides and Glitazones