Timing of SGLT2i initiation after acute myocardial infarction
Abstract Background Pharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-023-02000-5 |
| _version_ | 1827635688767488000 |
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| author | Dirk von Lewinski Ewald Kolesnik Faisal Aziz Martin Benedikt Norbert J. Tripolt Markus Wallner Peter N. Pferschy Friederike von Lewinski Nora Schwegel Rury R. Holman Abderrahim Oulhaj Deddo Moertl Jolanta Siller-Matula Harald Sourij |
| author_facet | Dirk von Lewinski Ewald Kolesnik Faisal Aziz Martin Benedikt Norbert J. Tripolt Markus Wallner Peter N. Pferschy Friederike von Lewinski Nora Schwegel Rury R. Holman Abderrahim Oulhaj Deddo Moertl Jolanta Siller-Matula Harald Sourij |
| author_sort | Dirk von Lewinski |
| collection | DOAJ |
| description | Abstract Background Pharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered “sick days drugs” and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation. Methods and results The EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: − 69.1; − 48.1) in the early group compared to 61.0% (− 76.0; − 41.4) in the intermediate and 61.9% (− 70.8; − 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups—initiation time interaction (pint = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected. Conclusion Very early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2–3 days. |
| first_indexed | 2024-03-09T15:31:02Z |
| format | Article |
| id | doaj.art-3c7f41c038ff40e78e36fef843171168 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-03-09T15:31:02Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-3c7f41c038ff40e78e36fef8431711682023-11-26T12:15:42ZengBMCCardiovascular Diabetology1475-28402023-09-012211710.1186/s12933-023-02000-5Timing of SGLT2i initiation after acute myocardial infarctionDirk von Lewinski0Ewald Kolesnik1Faisal Aziz2Martin Benedikt3Norbert J. Tripolt4Markus Wallner5Peter N. Pferschy6Friederike von Lewinski7Nora Schwegel8Rury R. Holman9Abderrahim Oulhaj10Deddo Moertl11Jolanta Siller-Matula12Harald Sourij13Department of Internal Medicine, Division of Cardiology, Medical University of GrazDepartment of Internal Medicine, Division of Cardiology, Medical University of GrazDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of GrazDepartment of Internal Medicine, Division of Cardiology, Medical University of GrazDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of GrazDepartment of Internal Medicine, Division of Cardiology, Medical University of GrazDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of GrazDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of GrazDepartment of Internal Medicine, Division of Cardiology, Medical University of GrazRadcliffe Department of Medicine, University of OxfordDepartment of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa UniversityKarl Landsteiner University of Health SciencesDepartment of Cardiology, Medical University of ViennaInterdisciplinary Metabolic Medicine Trials Unit, Medical University of GrazAbstract Background Pharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered “sick days drugs” and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation. Methods and results The EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: − 69.1; − 48.1) in the early group compared to 61.0% (− 76.0; − 41.4) in the intermediate and 61.9% (− 70.8; − 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups—initiation time interaction (pint = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected. Conclusion Very early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2–3 days.https://doi.org/10.1186/s12933-023-02000-5Myocardial infarctionSGLT2iTimingClinical trial |
| spellingShingle | Dirk von Lewinski Ewald Kolesnik Faisal Aziz Martin Benedikt Norbert J. Tripolt Markus Wallner Peter N. Pferschy Friederike von Lewinski Nora Schwegel Rury R. Holman Abderrahim Oulhaj Deddo Moertl Jolanta Siller-Matula Harald Sourij Timing of SGLT2i initiation after acute myocardial infarction Cardiovascular Diabetology Myocardial infarction SGLT2i Timing Clinical trial |
| title | Timing of SGLT2i initiation after acute myocardial infarction |
| title_full | Timing of SGLT2i initiation after acute myocardial infarction |
| title_fullStr | Timing of SGLT2i initiation after acute myocardial infarction |
| title_full_unstemmed | Timing of SGLT2i initiation after acute myocardial infarction |
| title_short | Timing of SGLT2i initiation after acute myocardial infarction |
| title_sort | timing of sglt2i initiation after acute myocardial infarction |
| topic | Myocardial infarction SGLT2i Timing Clinical trial |
| url | https://doi.org/10.1186/s12933-023-02000-5 |
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