Efficacy and safety of dapagliflozin in non-diabetic patients with anterior wall ST-segment elevation acute myocardial infarction (STEMI) in early-hospital period

Background Patients with type 2 diabetes mellitus, chronic kidney disease, and chronic heart failure benefit from sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy. Among patients with type 2 diabetes mellitus and a distant history of anterior wall myocardial infarction (MI), SGLT2 inhibitors also lower the risk of cardiovascular death and hospitalization for heart failure. It is appropriate to consider the possibility that, if initiated properly after the presentation of acute anterior wall STEMI, SGLT2 inhibition could enhance outcomes in patients. Objective This study aims to investigate the efficacy and safety of SGLT2 inhibitors when they are prescribed in the early stages of acute anterior wall STEMI in non-diabetic patients. Methods 132 non-diabetic patients with anterior wall ST-segment elevation acute myocardial infarction (STEMI) who underwent primary PCI and had LV EF≤ 45% and NT-proBNP ≥900 pg/ml at symptom start within 24 hours were included in this study. 66 patients received standard medical treatment including beta-blockers, ACE inhibitors (control group), while the other 66 patients had SGLT2 inhibitor Dapagliflozin 10 mg once a day added during the first 48 hours of inpatient treatment in addition to standard therapy(Dapa group). All patients were followed up for six months. Echocardiography was performed during the first 24 hours of hospital treatment and at the end of the 6th month. NT-proBNP was also repeated at the end of the sixth month. The primary endpoint was the change in NT-proBNP over six months, and secondary endpoints included changes in LVEF, hospitalization for heart failure, cardiovascular mortality over six months, and changes in plasma creatinine, and glycosylated hemoglobin. Results At the beginning of the study NT-proBNP levels were, on average, 1254.5 ±259.3pg/ml in the control group and 1311.3 pg/ml ±254 in the Dapa group (p=0.21). At the end of six months they were 1053.2±387.5 pg/ml and 889/2±215.5 pg/ml, respectively (p =0.003). The mean decline of NT-proBNP was 201.3±321.1 and 428.2±382.9 in Control and Dapa groups respectively (CI -306.9 -146.9, CL=95%; p < 0.001). In the control group, the mean LVEF was 39.1±3.5%, while in the Dapa group, it was 38.4±3.6% (p=0.27). Six months later, they were 40.7±4.9% and 42.8±3.3%, respectively (p=0.004). In the Control and Dapa groups, the mean increase in LVEF was 1.2±4.6 and 4.4±2.7, respectively (CI -4.6 -1.9, CL=95%; p < 0.001). Cardiovascular mortality during follow-up was 6.1% in the control group and 4.5% in the Dapa group(p =1), and hospitalization for heart failure was 19.6% and 7.6%, respectively (p =0.042). Other blood markers and side effects did not differ significantly across the groups. Conclusion Early administration of dapagliflozin in anterior wall STEMI patients without diabetes mellitus is associated with a statistically significant decrease in NT-proBNP, an increase in LVEF, and a better clinical outcome.