Effect of Dapagliflozin on Clinical Outcomes and Echocardiographic Parameters of Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention

Background The early initiation of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i), has emerged as a promising strategy to improve cardiovascular outcomes in patients with acute myocardial infarction (AMI). Evidence suggests that dapagliflozin can reduce adverse cardiac remodeling and improve cardiac function, particularly in those with heart failure. Aim and Objectives To evaluate the impact of early initiation of dapagliflozin on major adverse cardiovascular events (MACE) and its role in left ventricular (LV) structural recovery in patients with acute myocardial infarction (AMI) utilizing speckle-tracking echocardiography (STE) to assess myocardial deformation. Patients and Methods This single-center, prospective, single-blinded randomized controlled trial enrolled 200 patients with first-time AMI (STEMI or NSTEMI). All participants underwent successful percutaneous coronary intervention (PCI) and received standard guideline-directed medical therapy (GDMT). Patients were randomly assigned to Group I (dapagliflozin plus standard care) or Group II (standard care alone). Echocardiographic assessments were conducted at baseline (1–3 days post-AMI) and six months post-PCI to evaluate changes in global longitudinal strain (GLS), left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV). The primary endpoint was the composite of MACE six months post-AMI, while secondary endpoints included changes in GLS, LVEF, EDV, and ESV. Results While no statistically significant differences were observed in MACE rates between groups (Group I: 4%, Group II: 9%, p = 0.152), Group I demonstrated significant improvements in cardiac function parameters. At six months, Group I showed higher LVEF (52.24% vs. 47.66%, p = 0.025), The mean change in LVEF from baseline to follow-up was also greater in Group I (3.83%±5.96) compared to Group II (2.30%±5.13), although this difference did not reach statistical significance (p = 0.053). Group I showed greater reductions in ESV (-7.41±13.20 vs. -2.52±9.17, p = 0.003), and improved GLS (-14.50±3.27 vs. -13.48±3.77, p = 0.043). The change in LV global strain from baseline to follow-up was significantly greater in Group I (improvement of -1.467±3.023) compared to Group II (improvement of -0.475±2.252), with a statistically significant difference between the groups (p = 0.009). Subgroup analyses revealed enhanced myocardial recovery in diabetic, hypertensive, and CKD patients receiving dapagliflozin. Conclusion The early initiation of dapagliflozin during AMI did not significantly reduce MACE rates within six months but demonstrated notable improvements in cardiac function and LV remodeling parameters such as LVEF and GLS. These findings suggest that dapagliflozin may facilitate myocardial recovery through mechanisms beyond glycemic control, particularly in high-risk subgroups like diabetic, hypertensive and CKD patients.