在急性心肌梗塞后SGLT2i启动的时间
Dirk von Lewinski1, Ewald Kolesnik2, Faisal Aziz3,4
1Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. dirk.von-lewinski@medunigraz.at.
Cardiovascular diabetology
|September 30, 2023
概括
在心肌梗塞 (MI) 后非常早期开始使用SGLT2抑制剂 (SGLT2i) 是安全有效的. 这种方法在减少NT-proBNP和改善心脏功能方面显示了与延迟治疗相似的结果.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 代谢疾病 代谢疾病
背景情况:
- 心肌梗塞 (MI) 后的早期药理治疗是标准的,但对于不同药物类别的及时启动的证据有所不同.
- 虽然双重血小板治疗和他类药物已经确立了早期开始的益处,但对β-阻断剂和RAAS抑制剂的数据不那么确.
- 在EMMY试验中,通过皮肤冠状动脉干预 (PCI) 后早期使用-葡萄糖共载体2抑制剂 (SGLT2i) 有好处,但非常早期发病后冠状动脉干预的安全性和有效性尚不清楚,特别是在糖尿病患者中.
研究的目的:
- 评估急性心肌梗塞 (MI) 后非常早期启动的-葡萄糖共载体2抑制剂 (SGLT2i) 的安全性和有效性.
- 为了比较SGLT2i在24小时内启动的结果与MI后晚些时候启动 (24-72小时) 的结果.
- 评估启动时间对NT-proBNP水平,左心室功能和不良事件的影响.
主要方法:
- 该研究分析了EMMY试验的数据,重点关注在心脏病发作后接受empagliflozin治疗的患者.
- 患者被分为早期 (<24小时),中期 (24-<48小时) 和晚期 (48-72小时) 治疗启动组.
- 评估结果包括NT-proBNP,左心室喷射率 (LV-EF),心脏结构 (LVESD,LVEDD) 和严重不良事件的变化.
主要成果:
- 在所有启动组中,NT-proBNP水平显著下降,在早期,中期和晚期SGLT2i管理之间没有统计学上显著的差异 (pint=0.96).
- 二级终点,包括左心室功能 (LV-EF,e/e`) 和结构 (LVESD,LVEDD),在不同启动时间组中是可比的.
- 在早期和延迟SGLT2i启动组之间没有观察到严重不良事件发生率的显著差异.
结论:
- 在急性心肌梗塞之后,非常早期的SGLT2抑制剂的使用是安全的,并没有出现不利的信号.
- 发起SGLT2抑制剂非常早期的MI后,在降低NT-proBNP水平方面同样有效,而是在2-3天后开始它们.
- 早期SGLT2i启动也显示了与延迟启动相比,左心室结构和功能标志物的可比改善.
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