What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction and type 2 diabetes mellitus (n=961). Intervention: Dapagliflozin vs. Non-Dapagliflozin users (other glucose-lowering drugs). Primary outcome: Heart failure rehospitalization (HR 0.417, 95% CI 0.207-0.838, p=0.001).

What does this research mean for the field?

In patients with diabetic acute myocardial infarction, in-hospital and continued use of dapagliflozin significantly reduces the risk of heart failure rehospitalization compared to non-users. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 26, 2023Open Access

Dapagliflozin reduces risk of heart failure rehospitalization in diabetic acute myocardial infarction patients: a propensity score-matched analysis

Key Result

In patients with diabetic acute myocardial infarction, in-hospital and continued use of dapagliflozin significantly reduced the risk of heart failure rehospitalization (HR 0.417) compared to non-users.

Study Design

Type

Cohort (n=961)

Multicenter

Structured PICO

Does dapagliflozin reduce heart failure rehospitalization in adult patients with acute myocardial infarction and type 2 diabetes mellitus?

Population

961 adult patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) who underwent coronary angiography and percutaneous coronary intervention (PCI) during hospitalization, from the CZ-AMI registry (single-center, China). Mean age 61.97 (DAPA) / 67.22 (DAPA-free) before matching, 76.0% male (DAPA) / 65.7% male (DAPA-free).

Intervention

Dapagliflozin 10 mg oral once daily, initiated in-hospital and continued after discharge.

Comparator

Non-dapagliflozin users receiving other glucose-lowering drugs (including sulfonylureas, glinides, α-glucosidase inhibitors, DPP-4 inhibitors, insulin; no metformin used due to contrast agent exposure).

Outcome

Incidence of heart failure rehospitalization.hard clinical

In patients with type 2 diabetes and acute myocardial infarction, early in-hospital initiation and continuation of dapagliflozin significantly reduces the risk of subsequent heart failure rehospitalization.

Main Result

Effect estimate: HR 0.417 (95% CI 0.207-0.838)

Absolute Event Rate: 5.6% vs 15.2%

p-value: p=0.001

Limitations

Single-center retrospective study with a small sample size
Patients in the control group used several kinds of glucose-lowering drugs, the effects of which were not assessed separately
Efficacy and safety of other SGLT2 inhibitors were not evaluated
Patients discontinuing dapagliflozin use were excluded from the analysis, potentially lowering the observed incidence of adverse events

Abstract

OBJECTIVE: The aim of this study was to investigate the effect of dapagliflozin (DAPA) on the rate of heart failure rehospitalization in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM). METHODS: AMI patients with T2DM from CZ-AMI registry between January 2017 and January 2021 were enrolled in this study. Patients were stratified into DAPA users and non-DAPA users. The primary outcome was the incidence of heart failure rehospitalization. Kaplan-Meier analysis and Cox regressions were performed to evaluate the prognostic significance of DAPA. Propensity score matching (PSM) was performed to minimize the bias of confounding factors and facilitate the comparability between groups. The enrolled patients were matched with a propensity score of 1:1. RESULTS: A total of 961 patients were included, and 132 (13.74%) heart failure rehospitalizations occurred during a median follow-up of 540 days. In the Kaplan-Meier analysis, DAPA users had a statistically significantly lower rate of heart failure rehospitalization than non-DAPA users (p < 0.0001). Multivariate Cox analysis showed that DAPA was an independent protective factor for heart failure rehospitalization risk after discharge (HR = 0.498, 95% CI = 0.296 ~ 0.831, p = 0.001). After 1:1 propensity score matching, survival analysis showed a lower cumulative risk of heart failure rehospitalization in DAPA users than in non-DAPA users (p = 0.0007). In-hospital and continued use of DAPA remained significantly associated with a reduced risk of heart failure rehospitalization (HR = 0.417, 95% CI = 0.417 ~ 0.838, p = 0.001). Results were consistent across sensitivity and subgroup analyses. CONCLUSION: In patients with diabetic AMI, in-hospital and continued use of DAPA after discharge were associated with a significant lower risk of heart failure rehospitalization.

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