Abstract 13825: Post-PCI Outcomes in Patients on SGLT2 Inhibitor Therapy

Abstract

Introduction: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to improve cardiorenal outcomes among patients with and without diabetes mellitus. Hypothesis: We aimed to investigate their impact on the risk of acute kidney injury (AKI) and major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). Methods: Consecutive patients undergoing PCI at a high-volume PCI center between 2015 and 2022 were analyzed. Patients on SGLT2 inhibitors prior to PCI were compared to those not on SGLT2 inhibitors. The primary outcome was AKI, as defined as serum creatinine increase of ≥0.5 mg/dL or ≥25% from baseline within 30 days of PCI. MACE was defined as death or myocardial infarction (MI) and was assessed at 1 year post PCI. Results: There were significant differences in baseline clinical characteristics between patients on (n = 347) vs. not on (n = 16,594) SGLT2 inhibitors. Patients on SGLT2 inhibitors had higher prevalence of diabetes (90.5% vs. 45.5%), hypertension (96.8% vs. 92.1%), hyperlipidemia (95.7% vs. 90.5%), and prior CABG (21.0% vs 15.8%). SGLT2 inhibitor use was associated with a decreased rate of post-PCI AKI (3.3% vs. 6.6%; adjusted odds ratio [OR] 0.33; 95% confidence interval [CI] 0.08-0.89, P=0.025). At one year after PCI, patients on SGLT2 inhibitors had increased rates of MACE (8.2% vs. 3.9%; adjusted hazard ratio [HR] 1.74, 95% CI 0.99-3.06, P=0.052), driven by an increased risk of MI (6.9% vs. 2.1%; HR 2.63, 95% CI 1.42-4.90, P=0.002). Conclusions: SGLT2 inhibitor use was associated with lower post-PCI AKI, but was associated with an increased risk of MACE. The latter finding was driven by increased risk of MI, which may be explained by unmeasured confounders in these heterogeneous groups of patients.