Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients – DACAMI (a randomized controlled clinical trial). (15th May 2023)

• Record Type: Journal Article
• Authors: Dayem, Khairy Abdel; Younis, Omar; Zarif, Bassem; Attia, Sameh; AbdelSalam, Ahmed
• Is Part Of: International journal of cardiology. Volume 379(2023)
• Page Start: 9
• Page End: 14
• Publication Date: 2023-05-15
• Subjects: Dapagliflozin -- Sodium-glucose co-transporter 2 inhibitors -- Anterior STEMI -- Heart failure -- NT-proBNP; ACS Acute Coronary Syndrome -- EF Ejection fraction -- eGFR Estimated Glomerular filtration rate -- ePASP estimated pulmonary artery systolic pressure -- LV Left Ventricular -- LVEDd Left ventricular end-diastolic dimension -- LVESd Left ventricular end-systolic dimension -- NT-proBNP N-terminal pro-brain natriuretic peptide -- SGLT2 Sodium glucose co-transporter 2 -- SGLT2i Sodium-glucose co-transporter 2 inhibitor -- STEMI ST-Elevation Myocardial Infarction -- GDMT Guideline-directed Medical Therapy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2023.03.002
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed. Methods: In this dual center, double-blinded randomized controlled trial, non-diabetic patients ( N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide – NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. Results: From October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: −3.28–19.67, p -value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: −19.37 to −3.56, p-value 0.029). Conclusions: Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further. This trial is locally registered at the National Heart Institute, Cairo – Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov ) with identifier number: NCT05424315 – June 16th, 2022. Highlights: In-hospital initiation of dapagliflozin after acute anterior myocardial infarction may have a role in maintaining cardiac function and preventing heart failure post-MI. Patients taking dapagliflozin over a placebo had significantly lower levels of NT-proBNP and lower left ventricular mass index.