Effects Of Dapagliflozin On Short-term Prognosis And Risk Of Acute Kidney Injury In Patients With Acute Myocardial Infarction

Background:Acute myocardial infarction(AMI)is a common acute and urgent clinical illness with a high death rate.The rate of death has been greatly lowered due to the continual updating and advancement of percutaneous coronary intervention(PCI)techniques;nonetheless,the incidence of post-procedure-related acute kidney injury(AKI)remains high and is an independent risk factor for the long-and short-term prognosis of AMI patients.Sodium-dependent glucose transporters(SGLT2)inhibitors,a new hypoglycemic medication,have been found to contribute significantly to cardiorenal protection.However,it is unclear whether SGLT2 inhibitors can enhance AMI patients’ prognoses.Objective To investigate the effects of dapagliflozin on short-term prognosis and risk of acute kidney injury(AKI)in patients with acute myocardial infarction(AMI)complicated with type 2 diabetes mellitus(T2DM).Methods Patients with AMI and T2 DM who received intervention therapy in the Affiliated Changzhou No.2 People’s Hospital from June 2013 to August 2020 were retrospectively analyzed.During the patients’ hospitalization,clinical data were gathered,including demographics(gender,age),procedure-related indices(the culprit vessel of the left main coronary artery,left anterior descending,right coronary artery,left circumflex branch,contrast time and contrast dose),comorbidities(hypertension,and Killip score),smoking,alcohol drinking,laboratory indices [white blood cell count,serum creatinine,uric acid,glucose],and observation endpoints,including all-cause mortality,incidence of AKI and arrhythmias(new-onset atrial fibrillation,ventricular tachycardia,and ventricular fibrillation during hospitalization for all enrolled patients.They were separated into two groups,dapagliflozin group and non-dapagliflozin group,according to whether dapagliflozin treatment was given at the time of admission.The clinical data differences between the two groups were compared.To observe the difference in the occurrence of endpoint events during the follow-up period between the two groups of patients.The effects of dapagliflozin on the short-term prognosis of AMI patients withT2DM were assessed using multivariable logistic regression analysis.The Kaplan-Meier curve was used to evaluate the effects of dapagliflozin on the risk of all-cause mortality of AMI patients with T2 DM.Results1.Incidence rate A total of 2651 patients with AMI were enrolled in this study,among which 847 patients were complicated with T2 DM.160 patients(18.9%)were treated with dapagliflozin before procedure,and 687 patients(81.1%)were treated with other hypoglycemic drugs.46 patients(6.2%)died,16 patients(1.9%)developed arrhythmias during their hospitalization,and 154 patients(18.2%)developed AKI after interventional therapy.2.General clinical data Compared with non-dapagliflozin groups,patients with AMI and T2 DM in the dapagliflozin group were younger(years: 62.3±12.9 vs.68.3±12.4,P<0.05),had higher diastolic blood pressure [mm Hg(1 mm Hg≈0.133KPa):81.4±15.1 vs.78.4±16.0,P<0.05],lower serum creatinine(SCr)levels [μmol/L::67.6(57.8,80.8)vs.78.1(61.4,101.5),P<0.05],and the proportion of patients receiving coronary stent implantation and contrast time ≥ 60 minutes was higher [93.8%(150/160)vs.84.9%(583/687)and 23.1%(37/160)vs.13.8%(95/687),respectively;both P < 0.05].3.Endpoint Events: Compared to non-dapagliflozin group,the application of dapagliflozin resulted in a significant reduction in all-cause mortality in AMI patients [1.3%(2/160)vs.6.4%(44/687),P < 0.05].However,there was no statistically significant difference between the use of dapagliflozin on the risk of arrhythmia during hospitalization and the incidence of AKI after surgery in patients with AMI [0%(0/160)vs.2.3%(16/687),16.9%(27/160)vs.18.5%(127/687),both P>0.05].AMI patients who developed AKI exhibited higher mortality than those without AKI [11.4%(15/132)vs.5.3%(42/786),P = 0.008].4.Kaplan Meier survival curve analysis shows that dapagliflozin group was lower risk of all-cause mortality than non-dapagliflozin groups(Log-Rank :χ 2=28.924,P <0.001).After controlling for the effect of numerous confounding factors on outcome,multivariable logistic regression analysis revealed that the early use of dapagliflozin in AMI patients significantly reduced the risk of 30-day all-cause mortality after adjusted(odds ratio [OR]=0.233,95% confidence interval [CI]: 0.05-0.99,P = 0.048).Conclusions The use of dapagliflozin reduces the risk of all-cause death in AMIpatients with T2 DM.When compared to non-dapagliflozin group,the use of dapagliflozin did not increase the risk of AKI and arrhythmias after intervention therapy in patients with AMI and T2 DM.Dapagliflozin may offer a new strategy to improve the prognosis of AMI patients undergoing PCI.