Sodium–glucose cotransporter 2 inhibitor use in early-phase acute coronary syndrome with severe heart failure

Abstract

Aims Sodium—glucose cotransporter 2 inhibitor (SGLT2i) improves clinical outcomes in patients with heart failure (HF), but has limited evidence of SGLT2i use on early-phase acute coronary syndrome (ACS). We determined association of early SGLT2i use compared with either non-SGLT2i or dipeptidyl peptidase 4 inhibitor (DPP4i) in hospitalized patients with ACS. Methods and Results This retrospective cohort study that used the Japanese nationwide administrative claims database included patients hospitalized with ACS aged ≥ 20 years between April 2014 and March 2021. The primary outcome was a composite of all-cause mortality or HF/ACS rehospitalization. Using 1:1 propensity score matching, the association with outcomes of the early SGLT2i use (≤14 days after admission) compared with non-SGLT2i or DPP4i was determined according to the HF treatment. Among 388 185 patients included, 115 612 and 272 573 with and without severe HF, respectively. Compared to non-SGLT2i users, the SGLT2i users had a lower hazard ratio (HR) with the primary outcome (HR: 0.83, 95% confidence interval [CI]: 0.76–0.91, p < 0.001) in the severe HF group; however, there was no significant difference in the non-severe HF group (HR: 0.92, 95% CI: 0.82–1.03, p = 0.16). SGLT2i use showed a lower risk of the outcome in patients with severe HF and diabetes compared with DPP4i (HR: 0.83, 95% CI: 0.69–1.00, p = 0.049). Conclusion SGLT2i use in patients with early-phase ACS showed a lower risk of primary outcome in patients with severe HF but the effect was not apparent in patients without severe HF.

The Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors on Cardiovascular Outcomes and All-Cause Mortality in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

“…Sources: [12][13][14][15][16][18][19][20] SGLT2i, sodium-glucose cotransporter-2 inhibitor; MACE, major adverse cardiovascular events; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom All-cause mortality and cardiovascular mortality: We included six studies in the pooled analysis of comparing the risk of all-cause mortality between patients in SGLTi and the control group, and the results are shown in Figure 3. Pooled analysis showed that the risk of all-cause mortality was lower in patients receiving SGLTi compared to the control group (RR: 0.71; 95% CI: 0.50, 1.00; p-value: 0.05).…”

“…FIGURE 3: Effect of SGLT2i on all-cause mortalitySources:[14][15][16][17][18]20] SGLT2i, sodium-glucose cotransporter-2 inhibitors; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom…”