The Impact of Dapagliflozin on Cardiac LV Systolic Function in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Who Developed Post MI LV Dysfunction

Abstract

Abstract Aim and objectives To study the impact of dapagliflozin on LV systolic function in patients with ST Elevation Myocardial Infarction undergoing primary percutaneous Coronary Intervention who developed post MI LV dysfunction. Patients and Methods The study included 80 patient who presented with ST-segment elevation myocardial infarction and underwent primary PCI at the catheterization lab unit, Cardiology department, Ain Shams University. The patients were divided into 2 groups. The standard treatment was given to all patients according to the ESC guidelines including: ACEI or ARNi, a beta-blocker, and an MRA[1] uptitrated according to the clinical state of the patient. The study medication was 10 mg of dapagliflozin[1] given once daily in the morning to the case group and a placebo medication to the control group. LVEF was assessed in both groups post primary PCI and at follow-up after 3 months by the same Echo machine GE VIVED S5 after the procedure since first of June 2021 till end of January 2022. Results There were no statistically significant difference between both groups regarding gender distribution, mean age, and the incidence of different risk factors of CAD (smoking, Diabetes and hypertension). Regarding pain to door (PTD) time, there was no statistically significant difference between case and control groups (P-value = 0.695), and anterior STEMI was the most common presentation in both groups (90% in the case group and 77.5% in the control group in the control group). Subsequently, there was no statistically significant difference between case and control groups regarding TIMI flow, and post-MI EF with mean range 34.88% ± 3.55% in the case group and 34.58% ± 3.65% in the control group (P = 0.711). On the other hand, there was statistically significant improvement in follow-up EF in the case group which showed a mean range of 45.36% ± 7.13% in comparison with the control group which showed a mean range of 41.80% ± 6.93% (P = 0.027). Conclusion Dapagliflozin administration in the early phase after STEMI results in significant improvement in LV systolic function in comparison with the placebo. Abbreviations ACE-I: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; ARNI: Angiotensin receptor-neprilysin inhibitor; CBC: Complete blood picture; DM: Diabetes Mellitus; ECG: Electrocardiogram; FH: Family History; GLS: Global longitudinal strain; HF: Heart Failure; HFrEF: Heart Failure reduced Ejection Fraction; HTN: Hypertension IV: Intravenous; LV: Left ventricle; LVEF: Left ventricular ejection fraction; MI: Myocardial Infarction; MRA: Mineralocorticoid receptor antagonists; PCI: Primary percutaneous coronary intervention; SD: Standard deviation; SGLT-2: Sodium-glucose cotransporter-2 inhibitors; SPSS: Statistical Package for the Social Science; STEMI: ST-segment elevation myocardial infarction; T2D: Type 2 Diabetes Mellitus