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

Although recent large-scale randomized trials have demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors following acute myocardial infarction (AMI) are safe, the mechanisms underlying their potential cardioprotective effects remain poorly understood.

The aim of this study was to evaluate the effects of SGLT2 inhibitor therapy on myocardial injury and left ventricular (LV) remodeling in AMI patients undergoing percutaneous coronary intervention (PCI), using cardiac magnetic resonance imaging (CMR).

In this prospective, open-label, randomized controlled trial, patients ≥18 years of age at high risk for heart failure after successful PCI for AMI were randomly assigned to receive empagliflozin 10 mg once daily or not. The primary endpoint was infarct size (% LV mass) assessed by CMR at 6-month follow-up. The coprimary endpoint was a difference in LV end-systolic volume measured by CMR between baseline and 6 months (ΔLV end-systolic volume).

A total of 200 patients underwent randomization, with 100 assigned to the SGLT2 inhibitor group and 100 assigned to the control group. CMR assessments for 6 months were available for 169 patients (84.0%) of the total study population (89 patients in the SGLT2 inhibitor group and 80 patients in the control group). Compared with control, SGLT2 inhibition did not reduce infarct size (% LV mass) at 6-month follow-up (SGLT2 inhibitor vs control, 12.5% [8.5%-20.9%] vs 12.9% [5.0%-20.7%]; P = 0.92). There was no significant difference in ΔLV end-systolic volume between the 2 groups (SGLT2 inhibitor vs control, -3.3% [-19.7% to 13.6%] vs -6.8% [-23.4% to 10.6%]; P = 0.40).

Among patients with AMI undergoing PCI who were at high risk for heart failure, SGLT2 inhibitor use did not reduce infarct size or facilitate reverse LV remodeling at 6 months as assessed by CMR. (Peri-Treatment of SGLT-2 Inhibitor on Myocardial Infarct Size and Remodeling Index in Patients With Acute Myocardial Infarction and High Risk of Heart Failure Undergoing Percutaneous Coronary Intervention [PRESTIGE-AMI]; NCT04899479).