Sodium-Glucose Cotransporter 2 Inhibitors as Discharge Medications in Survivors of Acute Myocardial Infarction Complicated by Cardiogenic Shock.
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Daoulah Amin, Jamjoom Ahmed, Arafat Amr A, Yousif Nooraldaem, Almahmeed Wael, Arabi Abdulrahman, Panduranga Prashanth, Lotfi Amir, Abdirahman Kahin Mokhtar, Aloui Hatem M, Kanbr Omar, Alswuaidi Jassim, Alamro Bandar, Alshehri Mohammed, Alharbi Waleed, Alzahrani Badr, Al Obaikan Sultan, Alshali Khalid Z, Alenezi Abdullah, Al Maashani Said, Rajan Rajesh, Qutub Mohammed A, Balghith Mohammed, Hassan Taher, Alqahtani Abdulrahman M, Abdulhabeeb Ibrahim A M, Ghani Mohamed Ajaz, Fathey Hussien Adnan, Shawky Abeer M, Elmahrouk Youssef, Seraj Shaber, Elmahrouk Ahmed
Аннотация
METHODS: This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models.
RESULTS: Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629-1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients.
CONCLUSIONS: In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.