Key result
In diabetic patients with STEMI and multivessel non-obstructive coronary stenosis, current incretin use was associated with a 48.7% reduction in the risk of major adverse cardiac events at 12 months compared to never-incretin use.
Why the study?
Does prior incretin-based therapy reduce all-cause death, cardiac death, and MACE in type 2 diabetic patients presenting with a first STEMI and multivessel non-obstructive coronary stenosis?
Cohort (n=1,088)
Yes
Does prior incretin-based therapy reduce all-cause death, cardiac death, and MACE in type 2 diabetic patients presenting with a first STEMI and multivessel non-obstructive coronary stenosis?
Answers are grounded in this paper and cite their sources.
Incretin-based therapy is associated with a reduced risk of major adverse cardiac events at 12 months in type 2 diabetic patients presenting with a first STEMI and multivessel non-obstructive coronary stenosis.
BACKGROUND: No proper data on prognosis and management of type-2 diabetic ST elevation myocardial infarction (STEMI) patients with culprit obstructive lesion and multivessel non obstructive coronary stenosis (Mv-NOCS) exist. We evaluated the 12-months prognosis of Mv-NOCS-diabetics with first STEMI vs.to non-diabetics, and then Mv-NOCS-diabetics previously treated with incretin based therapy vs. a matched cohort of STEMI-Mv-NOCS never treated with such therapy. METHODS: 1088 Patients with first STEMI and Mv-NOCS were scheduled for the study. Patients included in the study were categorized in type 2 diabetics (n 292) and non-diabetics (n 796). Finally, we categorized diabetics in current-incretin-users (n 76), and never-incretin-users (n 180). The primary end point was all cause deaths, cardiac deaths, and major adverse cardiac events (MACE) at 12 months of follow up. RESULTS: The study results evidenced higher percentage of all cause deaths (2.2% vs. 1.1%, p value 0.05), cardiac deaths (1.6% vs. 0.5%, p value 0.045), and MACE (12.9% vs. n 5.9%), p value 0.001) in diabetic vs. no diabetic patients at 12 months follow up. Among diabetic patients, the current vs never-incretin-users, did not present a significant difference about all cause of deaths, and cardiac deaths through 12-months. The MACE rate at 1 year was 7.4% in diabetic incretin-users STEMI Mv-NOCS patients vs. 12.9% in diabetic never-incretin-users STEMI-Mv-NOCS patients (p value 0.04). In a risk-adjusted hazard analysis, MACE through 12 months were lower in diabetic STEMI-Mv NOCS incretin-users vs never-incretin-users patients (HR 0.513, CI [0.292-0.899], p 0.021). Consequently, lower levels of glucagon-like peptide 1(GLP-1) were predictive of MACE at follow up (HR 1.528, CI [1.059-2.204], p 0.024). CONCLUSION: Clinical trial number: NCT03312179, name of registry: clinicaltrialgov, URL: clinicalltrialgov.com, date of registration: September 2017, date of enrollment first participant: September 2009.
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Marfella et al. (2018) conducted a cohort in First STEMI with culprit obstructive lesion and multivessel non-obstructive coronary stenosis (Mv-NOCS) (n=1,088). Incretin-based therapy (GLP-1 agonists or DPP-4 inhibitors) vs. Never-incretin-users was evaluated on Major adverse cardiac events (MACE) at 12 months (HR 0.513, 95% CI 0.292-0.899, p=0.021). In diabetic patients with STEMI and multivessel non-obstructive coronary stenosis, current incretin use was associated with a 48.7% reduction in the risk of major adverse cardiac events at 12 months compared to never-incretin use.
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