在心力衰竭和之前的冠状动脉再血管化中使用empagliflozin:来自EMPEROR调查的见解
Nitish K Dhingra1, Javed Butler2, Stefan D Anker3
1Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
JACC. Advances
|January 29, 2026
概括
葡萄糖携带体-2 抑制剂有效治疗心力衰竭 (HF),无论之前的冠状动脉再血管化史. 恩帕格利弗洛辛在患者中表现出一致的疗效和安全性,这些患者之前有或没有进行过再血管化手术.
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.
背景情况:
- 糖共运输体-2 (SGLT2) 抑制剂对于治疗慢性心力衰竭 (HF) 是必不可少的.
- 调查SGLT2抑制剂在HF患者之前冠状动脉再血管化的有效性至关重要.
研究的目的:
- 为了确定SGLT2抑制剂对HF患者的益处是否在那些有冠状动脉再血管化的病史的人群中持续存在.
- 评估先前的再血管化对empagliflozin在高血压中疗效和安全性的影响.
主要方法:
- 对EMPEROR减少试验和EMPEROR保留试验的聚合分析 (EMPEROR聚合数据库).
- 患有HF的患者 (左心室喷射分数<40%或≥40%) 接受了empagliflozin或安慰剂.
- 主要结局:时间到第一个HF住院或心血管死亡. 基于重血管化史的亚组分析 (穿皮冠状动脉干预或冠状动脉旁路移植).
主要成果:
- 35.4%的患者有冠状动脉复血管化 (REVASC) 的病史.
- 在安慰剂组中,复血管化病史并没有增加初级结局或主要心脏和脑血管不良事件的风险.
- 恩帕格利弗洛辛显示一致的疗效 (主要结局的危险比:0.76在REVASC与0.77在没有REVASC) 和安全,无论重血管化状态 (P相互作用=0.94).
结论:
- 与没有HF的患者相比,患有HF和有重血管化的病史的患者具有类似的HF和缺血事件率.
- 在HF患者中,empagliflozin的疗效和安全性概况保持不论之前的再血管化.
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