C-58 | Kidney Outcomes with Sodium-Glucose Co-transporter-2 Inhibitors use in patients undergoing Revascularization for Acute Coronary Syndromes: A Propensity-Matched Analysis

Acute Kidney Injury (AKI) after percutaneous coronary intervention (PCI) is an independent predictor of poor clinical outcomes, including mortality. Given the concern that SGLT2i may exacerbate post-PCI AKI vis-a-vis afferent arteriolar constriction which may amplify the risk of tubular ischemia, most clinical guidelines recommend withholding SGLT2i during the peri-PCI period. In contrast, post-hoc pooled analyses of randomized trials with SGLT2i show a significant reduction in AKI risk over time. This analysis examines kidney outcomes in patients undergoing PCI for acute coronary syndrome (ACS) with concurrent use of SGLT2i. We searched the TriNetX database to identify patients > 18 years old, with either ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI, who underwent PCI from January 2019 to January 2023. Exclusion criteria include dialysis dependence, cardiogenic shock or the need for mechanical circulatory support. Patients were stratified into the SGLT2i cohort (on SGLT2i for at least 3 months before PCI) and no SGLT2i group (not taking SGLT2i before or up to 30 days after PCI). 1:1 nearest-neighbor propensity score matching was used to balance inter-group covariates. The primary outcome of interest was a clinical kidney composite (incidence of acute kidney injury (AKI) and new dialysis initiation) within 30 days post-PCI. There were 5507 (1786 had NSTEMI, 3721 had STEMI) patients in each cohort. Both groups were balanced in demographics, baseline comorbidities, and medication use (apart from more patients on insulin in non-SGLT2i and renin-angiotensin blockers in the SGLT2i group. In the SGLT2i group compared to the no SGLT2i group, the clinical kidney composite was significantly lower in those with baseline eGFR <15 cc/min (OR 0.54, 95% CI: 0.33 - 0.89, p=0.014) and those with eGFR 30 – 59 cc/min (OR 0.83, 95% CI: 0.73 - 0.95), with no difference in those with baseline eGFR 60 – 90 cc/min (OR 1.15, 95% CI: 0.97 - 1.36, p=0.102). SGLT2i exhibits a renoprotective effect peri-procedurally during PCI for ACS, with higher benefits in lower eGFR strata. Further research is necessary to identify appropriate use in patients at high risk for post PCI AKI with SGLT2i in addition to standard of care.