Early dapagliflozin administration before reperfusion in patients with anterior STEMI did not significantly improve left ventricular reverse remodeling (median LVEDVI change -2.3 vs -1.6 mL/m2; p=0.261).
RCT (n=20)
Double-blind
1:1
Does pre-reperfusion dapagliflozin reduce infarct size and improve ventricular remodeling in patients with anterior STEMI?
Early administration of dapagliflozin before reperfusion in patients with anterior STEMI is feasible but does not significantly reduce infarct size or improve ventricular remodeling at 3 months.
Absolute Event Rate: -2.3% vs -1.6%
p-value: p=0.261
Abstract Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown cardioprotective benefits in both diabetic and non-diabetic patients. Preclinical studies suggest that early SGLT2i administration may limit myocardial ischemia/reperfusion injury. However, its effect on infarct size and ventricular remodeling during the acute phase of myocardial infarction in humans is not well established. Cardiac magnetic resonance imaging (CMR) offers a reliable method to quantify infarct size, ventricular function, and microvascular obstruction (MVO). Objective To assess the impact of pre-reperfusion dapagliflozin on infarct size and left ventricular remodeling using CMR in patients with anterior ST-elevation myocardial infarction (STEMI). Methods This is a randomized, double-blind, placebo-controlled study. Patients with anterior wall STEMI were randomized 1:1 to receive dapagliflozin (20 mg loading, then 10 mg daily) or placebo before coronary reperfusion. CMR was performed at early days and 3 months post-PCI to evaluate left ventricular volumes, ejection fraction (LVEF), infarct size (%LV mass), and MVO. Imaging was interpreted blinded to treatment allocation. Results Twenty patients with anterior wall STEMI were enrolled: 11 (55%) received dapagliflozin, while 9 (45%) received a placebo. The mean age was 67.2 ± 7.0 years, and 70% were male. Baseline infarct size was not significantly different between the two groups (36.1% vs. 31.2%, p = 0.176). MVO was present in 73% of patients receiving dapagliflozin compared to 75% of those receiving placebo (p = 0.912). At the 3-month follow-up, dapagliflozin did not result in significant reverse remodeling compared to the placebo. Median change in left ventricular end-diastolic volume index was -2.3 mL/m2 (IQR: -3.3 to 16.9) in the dapagliflozin group vs. -1.6 mL/m2 (IQR: -14.4 to 4.2) in the placebo group (p = 0.261). Median change in left ventricular end-diastolic volume index was -1.3 mL/m2 (IQR -3.3 to 3.7) vs. -2.3 mL/m2 (IQR -15.4 to 0.6), respectively (p = 0.331). Conclusion Early dapagliflozin administration before reperfusion was feasible, however, it did not significantly reduce infarct size or MVO. Further studies with larger sample sizes, longer dapagliflozin duration and follow-up are warranted to clarify its role in myocardial protection during acute myocardial infarction.Table 1.Baseline demographic and clinic Table 2.Cardiac magnetic resonance Char
Noparatkailas et al. (Thu,) conducted a rct in anterior ST-elevation myocardial infarction (STEMI) (n=20). dapagliflozin vs. placebo was evaluated on change in left ventricular end-diastolic volume index (p=0.261). Early dapagliflozin administration before reperfusion in patients with anterior STEMI did not significantly improve left ventricular reverse remodeling (median LVEDVI change -2.3 vs -1.6 mL/m2; p=0.261).