Study On The Degree Of Protection And Short-Term Prognosis Of SGLT2I Against Myocardial Injury In STEMI Patients With T2DM

Objective(s):The purpose of this study was to explore the effect of sodium glucose type 2cotransporter inhibitor on myocardial injury and short-term prognosis in patients with acute myocardial infarction complicated with diabetes.Methods:1 Research object:Collect data from Kunming Medical Department from April 2019to May 2023 regarding acute myocardial infarction with ST segment elevation Patients with type 2 diabetes were hospitalized in the Department of Cardiology of the First Affiliated Hospital of the University and directly treated with PCI.2 groups:Patients were divided into SGLT2i group(experimental group)and non SGLT2i group(control group)based on whether they took SGLT2i before the onset of myocardial infarction.3 Data collection:3.1 Myocardial Necrosis Markers:During hospitalization,both the experimental group and the control group underwent myocardial necrosis marker detection(creatine kinase,creatine kinase isoenzyme,and troponin I),and the degree of myocardial injury in patients was evaluated based on their enzyme peaks;Myoglobin(MYO),creatine kinase isoenzyme(CK-MB),and troponin I(CTn I)were tested once at admission,4hours,8 hours,12 hours,24 hours,36 hours,and 48 hours,respectively.3.2 Cardiac Color Doppler Ultrasound:Complete echocardiography examination 5-7days after PCI,and collect indicators such as left atrial diameter,left ventricular diastolic end diameter,left ventricular ejection fraction,right atrial mid transverse diameter,right atrial long diameter,right ventricular outflow tract diameter,and mitral valve E/A peak.3.3 MACE events refer to the occurrence of major adverse cardiovascular events(including target vessel reconstruction,recurrent myocardial infarction,cardiogenic shock,heart failure,and cardiogenic death)within 30 days after PCI in follow-up patients.3.4 General information:Organize and collect clinical data of all patients,including basic patient information characteristics,general medical history,comorbidities,laboratory examinations,and imaging examinations.3.5 Statistical method:SPSS22.0 software system is used to process the analysis.Descriptive statistical continuous variables are expressed in mean±standard deviation,and categorical variable are expressed in frequency and percentage.The comparison between the two groups of measurement variables that conform to the normal distribution uses the independent sample t test,and the enumeration data uses the X~2test or Fisher exact test;Paired t-tests were used to compare the differences between different nodes of the same observation object.For data that do not conform to the normal distribution,Mann Whitmey U test was used to compare the differences between groups,and paired Wilcoxon signed rank test was used to compare the differences between baseline and follow-up within groups.Simultaneously applying multiple linear regression and COX regression to analyze the impact of observation factors involved in the original study on endpoint events,the difference was statistically significant(P<0.05).This t-test uses X~2test or Fisher’s exact test for counting data;with Paired t-tests were used for comparison of differences.For data not conforming to normal distribution,Compare the differences between groups and perform the paired Wilcoxon signed rank test for grouping.Results:1 Comparison of clinical data of selected patients in SGLT2i group and non-SGLT2i group1.1 A total of 200 patients were selected for the study,including 102(51%)in the SGLT2i group and 98(49%)in the non SGLT2i group.After comparison,two groups of patients had age,gender,BMI blood pressure,coronary heart disease risk factors(hypertension,hyperlipidemia,smoking),history of myocardial infarction,Killip grade,blood indicators(WBC,NEU%,BNP,blood creatinine,and admission Glucose,glycosylated hemoglobin),the use of other hypoglycemic drugs,infarct related arteries,the time from admission to balloon dilation,preoperative coronary blood flow classification and postoperative coronary blood flow classification showed no significant difference after comparison(P>0.05).1.2 Compared with the non SGLT2i group,the postoperative LVEF of the SGLT2group was significantly higher(51.62%±6.38%vs 47.71%±7.49%,P<0.05),and the difference was statistically significant.1.3 Compared with the non SGLT2i group,the postoperative LVEDD of patients in the SGLT2i group decreased significantly(46.91mm±3.51mm vs 50.42mm±6.52mm,P<0.05).2 Comparison of cardiac ultrasound indicators(LVEDD,LVEF)between two groups of patients using multiple linear regression analysis.2.1 LVEF-multiple linear regression analysisAfter the comparison of basic data,the indicators with P<0.2 were again included in the multiple linear regression analysis for screening of confounding factors(as admission blood glucose was greatly affected by irritability blood glucose rise,it was not included in the multiple linear regression analysis temporarily).Compared with the SGLT2i group,patients in the non SGLT2i group had lower LVEF values without considering other confounding factors;After adjusting for confounding factors such as age,diastolic blood pressure,white blood cell count,and glycated hemoglobin,the LVEF values of patients in the non SGLT2i group were still low,P<0.05,and the difference was statistically significant.2.2 LVEDD multiple linear regression analysisAfter the comparison of basic data,the indicators with P<0.2 were again included in the multiple linear regression analysis for screening of confounding factors(as admission blood glucose was greatly affected by irritability blood glucose rise,it was not included in the multiple linear regression analysis temporarily).Compared with the SGLT2i group,patients in the non SGLT2i group had higher LVEDD values without considering other confounding factors;After adjusting for confounding factors such as age,diastolic blood pressure,white blood cell count,and glycated hemoglobin,the LVEDD values of patients in the non SGLT2 group were still higher,with a statistically significant difference of P<0.05.3 Comparison of myocardial enzyme peak levels between the 3SGLT2i group and the non SGLT2 groupThe comparison results showed that CK(1712.37±56.46ng/ml vs 1997.76±513.78ng/ml,P<0.05),CK-MB(208.65±64.80ng/ml vs 229.35±53.78 ng/ml,P<0.05),c Tn I(5.34±0.99ng/ml vs 7.82±1.12ng/ml,P<0.05),and the enzyme peaks of CK,CK-MB,and c Tn I myocardial necrosis markers in patients in the SGLT2i group were lower than those in the non SGLT2 group,P<0.05,and the differences were statistically significant.4 Comparison of Area Under the Curve of 4 Myocardial Necrosis Markers4.1 Compared with the non SGLT2 group,patients in the SGLT2 group had lower myocardial necrosis marker CK-MB enzyme peaks and smaller area under the curve,with P values all lower than 0.05(P<0.05),indicating statistically significant differences.4.2 Compared with the non SGLT2 group,patients in the SGLT2 group had lower myocardial necrosis marker CK enzyme peaks and smaller area under the curve,with P values all lower than 0.05(P<0.05),indicating statistically significant differences.4.3 Compared with the non SGLT2i group,patients in the SGLT2 group had lower CTn enzyme peaks and smaller area under the curve,with P values all lower than 0.05(P<0.05),and the differences were statistically significant.5 The incidence of MACE at 30 days after 5PCIAfter 30 days of follow-up after PCI,the incidence of MACE in the SGLT2i group was(5.88%)compared to the non SGLT2i group(15.31%),with a statistically significant difference(P<0.05).Further MACE event survival curve analysis was performed,including target vessel reconstruction events(X~2value 0.3585,P value0.5345),recurrent myocardial infarction events(X~2value 1.041,P value 0.307 6),cardiogenic shock events(X~2value 1.115,P value 0.291),and heart failure events(X~2value 4.797,P value 0.0285),Cardiogenic death events(X~2value 1.041,P value 0.3076),total MACEs events(X~2value 4.894,P value 0.0269),with total MACEs events and heart failure events with P values less than 0.05(all<0.05).It has statistical significance.6 COX regression analysis of 6 endpoint events6.1 COX regression analysis results of total MACEs events:COX regression analysis results of total MACEs events:After adjustment for LVEF and CTNIAUC,the SGLT2I group had a lower overall MACEs event incidence compared to the non SGLT2I group,with a statistically significant difference(P<0.05).6.2 COX regression analysis results of heart failure events:After LVEDD correction,the incidence of heart failure events in the SGLT2i group was lower than that in the non SGLT2i group,and the difference was statistically significant(P<0.05).Conclusion(s):1 Patients with STEMI combined with T2DM who have previously used SGLT2i effectively can alleviate myocardial damage after ischemia-reperfusion,inhibit cardiac remodeling,and improve cardiac function.2 Patients with STEMI and T2DM who effectively use SGLT2i have a lower risk of MACE events within 30 days after PCI.