Abstract 14605: Association of SGLT-2 Inhibition With Size of Myocardial Infarction in Patients With Type 2 Diabetes Mellitus

Abstract

Introduction: Preclinical data suggest that sodium-glucose-cotransporter-2 inhibitors (SGLT-2i) reduce the size of myocardial infarction (MI). This study aimed to assess the association of SGLT-2i use with the size of MI and clinical outcome. Methods: In a retrospective single center cohort study, patients with diagnosed diabetes mellitus type 2 who were admitted for MI and treated with PCI between November 2015 and November 2022 were analyzed and grouped according to SGLT-2i use. Following PCI, serial high sensitivity troponin T (cTn, Roche) measurements were performed according to in-house protocol. The primary outcome was the size of MI determined by the peak cTn normalized on the endangered myocardial area (EMA) calculated according to culprit lesion localization and coronary arterial dominance. Secondary outcomes were in-hospital adverse events (i.e. in-hospital death or stroke) and length of intensive care unit (ICU) treatment. The propensity score method was used to assess the association with outcomes. Results: 631 patients were identified: 85 with ongoing SGLT-2i therapy and 537 with other antidiabetic medication. Patients using SGLT-2i were younger (median age [years]: 67 [interquartile range, IQR 59-73] vs. 73 [64-79], p<0.01) and had a higher eGFR at admission (75 [57-91] vs. 68 [49-88] ml/min/1.73m 2 , p=0.03). The median cTn samples per patient was 6 (5-8). There was no significant difference in the peak cTn levels between the two groups (SGLT-2i use vs. no SGLT-2i use: 53 (12-173) vs. 65 (20-174) х the upper limit of normal [ULN], p=0.26). After augmented inverse-probability weighted propensity score matching, ongoing SGLT-2i therapy was significantly associated with a reduced MI size (difference between means: -2.19 [95% confidence interval, -4.07 to -0.31] x ULN/EMA (1/%), p=0.02). SGLT-2i use was associated with less in-hospital adverse events (-4.69 [-8.70 to -0.69] %, p=0.02) and with less days on ICU (-0.27 [-0.53 to -0.01] days, p=0.045). Conclusion: In this retrospective cohort study of patients with DM presenting with MI, prior prescription of SGLT-2i was associated with reduced MI size and fewer adverse events during hospitalization. This might indicate that SGLT2i reduces the size of MI.