Key result
Treatment with SGLT2 inhibitors in patients with type 2 diabetes mellitus and extensive coronary artery disease was associated with a significantly reduced risk of all-cause death (HR 0.32).
Why the study?
SGLT2 inhibitors reduce cardiovascular mortality and heart failure admissions in type 2 diabetes mellitus and cardiovascular disease, but no specific studies exist in patients with high-risk coronary artery disease.
Does SGLT2-I treatment reduce all-cause mortality in patients with T2DM and extensive coronary artery disease?
Observational (n=420)
No
Does SGLT2-I treatment reduce all-cause mortality in patients with T2DM and extensive coronary artery disease?
In patients with T2DM and extensive coronary artery disease, SGLT2-I therapy at discharge is associated with a significant reduction in all-cause mortality and improved renal function, though it may be associated with increased unplanned revascularizations.
Answers are grounded in this paper and cite their sources.
May support SGLT2-I in T2DM with extensive CAD; leaves open need for RCTs before practice change.
INTRODUCTION: Sodium-glucose type 2 cotransporter inhibitors (SGLT2-I) have shown solid benefits in reducing cardiovascular mortality and admissions for heart failure in patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, no specific studies exist in patients with high-risk coronary artery disease (CAD). METHODS: Single-center, retrospective, observational study including patients with T2DM and a new diagnosis of extensive CAD (defined as left main disease or three main coronary vessel disease). Patients were recruited from 2015 until 2020, with a follow-up of at least 12 months. The primary outcome was to compare all-cause mortality in patients treated with or without SGLT2-I at discharge and adjusted by inverse probability of treatment weighting (IPTW) propensity score. RESULTS: A total of 420 patients were included: 104 (24.7%) were treated with SGLT2-I and 316 (75.3%) were not (non-SGLT2-I group). The presentation was acute coronary syndrome in 44.3%. The mean age was 71.2 ± 10.5 years. The mean left ventricular ejection fraction was 51.5 ± 12.5%, and the mean estimated glomerular filtration rate was 73.9 ± 22 ml/min. After a mean follow-up of 3 ± 1.6 years, all-cause mortality was 16.4%, and cardiovascular mortality was 9.5%. After IPTW, the risk of all-cause death was lower in the SGLT2-I group with a hazard ratio of 0.32 (95% confidence interval 0.12-0.81), p = 0.016. With regard to secondary outcomes, patients in the SGLT2-I group were associated with less renal function deterioration but an increase in unplanned revascularizations. CONCLUSIONS: In patients with T2DM and extensive CAD, treatment with SGLT2-I after discharge was associated with a reduced risk of all-cause death.
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Chipayo-Gonzales et al. (2023) conducted an observational in Type 2 diabetes mellitus and extensive coronary artery disease (n=420). SGLT2 Inhibitors vs. Non-SGLT2 Inhibitors (standard antidiabetic drugs) was evaluated on All-cause mortality (HR 0.32, 95% CI 0.12-0.81, p=0.016). Treatment with SGLT2 inhibitors in patients with type 2 diabetes mellitus and extensive coronary artery disease was associated with a significantly reduced risk of all-cause death (HR 0.32).
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