Abstract 16587: Sodium Glucose Cotransporter-2 Inhibitors Post Acute Coronary Syndrome Induced New Heart Failure

Abstract

Introduction: Patients with acute coronary syndrome (ACS) have an unmet need for further risk reduction in major adverse cardiovascular events (MACE) and heart failure (HF) development despite guideline-directed medical therapy. As sodium glucose cotransporter-2 inhibitors (SGLT2i) are cardioprotective, in this study, we assessed the effectiveness of SGLT2i post-ACS with new onset HF. Hypothesis: SGLT2i use improves the effectiveness outcomes post-ACS induced new HF. Methods: We conducted a retrospective observational cohort study that included all diabetic patients admitted to the main tertiary cardiology center in Qatar between 1/06/2017 and 1/06/2021 with ACS complicated by new HF defined as new clinical HF requiring diuretics during the index admission, or ejection fraction (EF) <40%. We divided the study population in two groups; (1) SGLT2i users; (2) non-SGLT2i users. Primary outcomes were evaluated at 30 and 360 days, including a composite of ACS, HF hospitalization, and all-cause mortality. A propensity score-matched model (1:1) was used to adjust for baseline characteristics between the study groups. Cox proportional hazard regression analysis was used to evaluate the outcomes. P-value <0.05 indicated statistical significance. Results: We included 465 ACS patients who met the eligibility criteria (93% male, mean age 55±10 years, and 72% Asian). Using 1:1 propensity score matching, 78 patients were included per arm with an absolute standardized difference <0.1 for all baseline characteristics. The use of SGLT2i post ischemia-induced new HF resulted in lower composite outcomes at 30 and 360 days [ 30-day: 2.6% vs. 11.5%, HR= 0.20 (0.04-0.94), P =0.041; 360-Day: 14.1% vs. 23.1, HR= 0.46 (0.22-0.99), P= 0.046]. Conclusions: Our findings suggest cardioprotective effects of SGLT2i post-ACS induced new HF, which widens the SGLT2i spectrum of indications and may encourage cardiologists to prescribe SGLT2i for this population.