Cardiology research and practice · 2026
Dapagliflozin Augmentation of Sacubitril/Valsartan Therapy in Patients With Heart Failure Following PCI-Treated Acute Myocardial Infarction: A Meta-Analysis of Clinical Efficacy and Safety.
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Tang Tang, Yu Huimin, Zhang Yun, Li Shuang, Guo Mu
Аннотация
PURPOSE: To systematically review the efficacy and safety of dapagliflozin and sacubitril/valsartan (SV) in patients with heart failure (HF) following percutaneous coronary intervention (PCI)-treated acute myocardial infarction (AMI) and to provide evidence for clinical practice.
METHODS: Seven electronic databases were systematically searched from their inception to July 25, 2024. Following literature screening, data extraction, and risk of bias assessment, 14 randomized controlled trials involving 1310 patients were included. A meta-analysis was subsequently conducted using RevMan 5.4 and Stata 18.
RESULTS: Meta-analysis results showed that dapagliflozin combined with SV was superior to the control in improving left ventricular ejection fraction (LVEF) (WMD = 3.79, 95% CI: 2.70∼4.87; p < 0.001) and reducing N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (WMD = -83.49, 95% CI: -129.33∼-37.65; p = 0.0004). This combination also significantly reduced left ventricular end-diastolic diameter (LVEDD) (WMD = -2.27, 95% CI: -3.64∼-0.90; p = 0.001), left ventricular end-systolic diameter (LVESD) (WMD = -3.29, 95% CI: -3.98∼-2.59; p < 0.001), left ventricular remodeling index (LVRI) (WMD = -0.08, 95% CI: -0.10∼-0.06; p < 0.001), and left ventricular mass index (LVMI) (WMD = -8.84, 95% CI: -12.25∼-5.43; p < 0.001), while increasing the 6-min walking distance (6MWD) (WMD = 51.74, 95% CI: 32.33∼71.14; p < 0.001). Compared with SV monotherapy, adding dapagliflozin reduced major adverse cardiovascular event (MACE) incidence (OR = 0.24, 95% CI: 0.15∼0.39; p < 0.001). However, no significant difference in adverse drug events (ADEs) was observed. Subgroup analyses revealed no significant differences in NT-proBNP (WMD = -194.85, 95% CI: -396.53∼6.82; p = 0.06), LVEDD (WMD = -1.50, 95% CI: -3.90∼0.89; p = 0.22), or the incidence of ADE (OR = 1.26, 95% CI: 0.74∼2.14; p = 0.39) when the follow-up duration was short (≤ 12 w). Additionally, significant heterogeneity was observed across studies for most outcomes. However, this heterogeneity was markedly reduced in the long-term follow-up subgroup (≥ 24 w), and the results were consistent with those of previous meta-analyses.
CONCLUSION: Current evidence suggests that early initiation of dapagliflozin combined with SV offers superior efficacy and cardiovascular benefits for patients with HF following PCI-treated AMI. These benefits become increasingly evident with sustained treatment. Nevertheless, these conclusions warrant validation through more high-quality evidence.
METHODS: Seven electronic databases were systematically searched from their inception to July 25, 2024. Following literature screening, data extraction, and risk of bias assessment, 14 randomized controlled trials involving 1310 patients were included. A meta-analysis was subsequently conducted using RevMan 5.4 and Stata 18.
RESULTS: Meta-analysis results showed that dapagliflozin combined with SV was superior to the control in improving left ventricular ejection fraction (LVEF) (WMD = 3.79, 95% CI: 2.70∼4.87; p < 0.001) and reducing N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (WMD = -83.49, 95% CI: -129.33∼-37.65; p = 0.0004). This combination also significantly reduced left ventricular end-diastolic diameter (LVEDD) (WMD = -2.27, 95% CI: -3.64∼-0.90; p = 0.001), left ventricular end-systolic diameter (LVESD) (WMD = -3.29, 95% CI: -3.98∼-2.59; p < 0.001), left ventricular remodeling index (LVRI) (WMD = -0.08, 95% CI: -0.10∼-0.06; p < 0.001), and left ventricular mass index (LVMI) (WMD = -8.84, 95% CI: -12.25∼-5.43; p < 0.001), while increasing the 6-min walking distance (6MWD) (WMD = 51.74, 95% CI: 32.33∼71.14; p < 0.001). Compared with SV monotherapy, adding dapagliflozin reduced major adverse cardiovascular event (MACE) incidence (OR = 0.24, 95% CI: 0.15∼0.39; p < 0.001). However, no significant difference in adverse drug events (ADEs) was observed. Subgroup analyses revealed no significant differences in NT-proBNP (WMD = -194.85, 95% CI: -396.53∼6.82; p = 0.06), LVEDD (WMD = -1.50, 95% CI: -3.90∼0.89; p = 0.22), or the incidence of ADE (OR = 1.26, 95% CI: 0.74∼2.14; p = 0.39) when the follow-up duration was short (≤ 12 w). Additionally, significant heterogeneity was observed across studies for most outcomes. However, this heterogeneity was markedly reduced in the long-term follow-up subgroup (≥ 24 w), and the results were consistent with those of previous meta-analyses.
CONCLUSION: Current evidence suggests that early initiation of dapagliflozin combined with SV offers superior efficacy and cardiovascular benefits for patients with HF following PCI-treated AMI. These benefits become increasingly evident with sustained treatment. Nevertheless, these conclusions warrant validation through more high-quality evidence.