Empagliflozin in acute myocardial infarction in patients with and without type 2 diabetes

Aims: In the EMPACT-MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empaglif...

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Authors: Petrie, Mark|||0000-0002-6333-9496, Udell, Jacob|||0000-0001-7402-9584, Anker, Stefan|||0000-0002-0805-8683, Harrington, Josephine|||0000-0001-5169-117X, Jones, W. Schuyler|||0000-0002-7288-9596, Mattheus, M., Gasior, T., van der Meer, P., Amir, Offer|||0000-0002-5624-2450, Bahit, Maria Cecilia|||0000-0001-6179-4076, Bauersachs, Johann|||0000-0002-9341-117X, Bayés-Genís, Antoni|||0000-0002-3044-197X, Chopra, Vijay|||0000-0001-9512-1718, Januzzi, James L, Lopes, Renato D.|||0000-0003-2999-4961, Ponikowski, Piotr|||0000-0002-3391-7064, Rossello, X., Schou, Morten|||0000-0002-4271-2466, Zieroth, S., Brueckmann, Martina|||0000-0003-1215-0746, Sumin, Mikhail|||0000-0002-3827-5793, Bhatt, D.L., Hernandez, A.F., Butler, Javed|||0000-0001-7683-4720
Format: article
Publication Date:2024
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:309329
Online Access:https://ddd.uab.cat/record/309329
https://dx.doi.org/urn:doi:10.1002/ejhf.3548
Access Level:Open access
Keyword:Acute myocardial infarction
Diabetes
Empagliflozin
Heart failure
Description
Summary:Aims: In the EMPACT-MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empagliflozin in those with and without T2DM in acute MI is unknown. Methods and results: A total of 6522 patients with acute MI with newly reduced left ventricular ejection fraction (LVEF) to <45%, congestion, or both, were randomized to empagliflozin 10 mg or placebo. The primary endpoint was time to first HF hospitalization or all-cause death. Rates of endpoints with and without T2DM and the efficacy and safety of empagliflozin according to T2DM status were assessed. Overall, 32% had T2DM; 14% had pre-diabetes; 16% were normoglycaemic; 38% had unknown glycaemic status. Patients with T2DM, compared to those without T2DM, were at higher risk of time to first HF hospitalization or all-cause death (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.06-1.95) and all-cause death (HR 1.70; 95% CI 1.13-2.56). T2DM did not confer a higher risk of first HF hospitalization (HR 1.22, 95% CI 0.82-1.83). Empagliflozin reduced first and total HF hospitalizations, but not all-cause mortality, regardless of presence or absence of T2DM. The safety profile of empagliflozin was the same with and without T2DM. Conclusion: Patients with acute MI, LVEF <45% and/or congestion who had T2DM were at a higher risk of mortality than those without T2DM. Empagliflozin reduced first and total HF hospitalizations regardless of the presence or absence of T2DM.

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