SGLT2 Inhibitor on Infarct Size and LV Remodeling by CMR in Patients With AMI

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Recent trials show sodium-glucose cotransporter 2 (SGLT2) inhibitors are safe post-acute myocardial infarction (AMI).
• The cardioprotective mechanisms of SGLT2 inhibitors in AMI patients remain unclear.
• Understanding these mechanisms is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate the impact of SGLT2 inhibitor therapy on myocardial injury and left ventricular (LV) remodeling in AMI patients.
• To assess changes using cardiac magnetic resonance imaging (CMR) after percutaneous coronary intervention (PCI).
• To investigate the efficacy of empagliflozin in reducing infarct size and improving LV remodeling.

Main Methods:

• A prospective, open-label, randomized controlled trial involving 200 high-risk AMI patients undergoing PCI.
• Patients were randomized to receive empagliflozin or standard care.
• Primary endpoint: infarct size (% LV mass) by CMR at 6 months; coprimary endpoint: change in LV end-systolic volume.

Main Results:

• Empagliflozin did not significantly reduce infarct size compared to the control group (12.5% vs 12.9%, P=0.92).
• No significant difference was observed in the change of LV end-systolic volume between the SGLT2 inhibitor and control groups.
• CMR assessments at 6 months were available for 169 patients (84.0%).

Conclusions:

• SGLT2 inhibitor use did not reduce infarct size in high-risk AMI patients undergoing PCI.
• Empagliflozin did not facilitate reverse LV remodeling at 6 months post-AMI.
• The PRESTIGE-AMI trial (NCT04899479) did not confirm the hypothesized benefits of SGLT2 inhibitors on infarct size and remodeling.