Abstract
Background: Early initiation of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, may improve cardiovascular outcomes in acute myocardial infarction (AMI) by mitigating adverse remodeling and enhancing cardiac function. Objectives: To assess dapagliflozin’s impact on major adverse cardiovascular events (MACE) and left ventricular (LV) recovery in non-diabetic AMI patients using speckle-tracking echocardiography (STE). Methods: This prospective, single-blinded randomized controlled trial (RCT) enrolled 200 non-diabetic patients with a first episode of AMI, including both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), following successful percutaneous coronary intervention (PCI). Participants received guideline-directed therapy and were randomized to dapagliflozin + standard care (Group I, n=100) or standard care alone (Group II, n=100). Echocardiographic parameters, including left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), LV end-diastolic volume (EDV), and LV end-systolic volume (ESV), were measured at baseline (1–3 days after acute myocardial infarction [AMI]) and at 6-month follow-up.
. Primary endpoint: 6-month MACE; secondary endpoints: cardiac function changes. Results: MACE rates showed no significant difference (Group I: 4% vs. Group II: 9%; p=0.152). Group I demonstrated superior cardiac improvement: higher LVEF (52.24% vs. 47.66%; p=0.025), greater ESV reduction (−7.41±13.20 mL vs. −2.52±9.17 mL; p=0.003), and improved GLS (−14.50±3.27% vs. −13.48±3.77%; p=0.043). GLS change was significantly greater in Group I (Δ−1.467±3.023% vs. Δ−0.475±2.252%; p=0.009). Hypertensive and chronic kidney disease (CKD) subgroups showed enhanced myocardial recovery with dapagliflozin. Conclusion: Early dapagliflozin in non-diabetic AMI patients did not reduce 6-month MACE but significantly improved LV function and remodeling, suggesting cardioprotective benefits beyond glycemic control, especially in high-risk subgroups.
Recommended Citation
Salem, Hazem Salama Emad; El-Mawardy, Ramzy Mohamed; Zahran, Mohamed Elsayed; Bastawy, Islam Mohamed; Aziz, Mina Fahim; and Attia, Abdelrahman Elsayed
(2025)
"Early Dapagliflozin in Non-Diabetic Acute Myocardial Infarction Patients Post-PCI: Effects on Cardiovascular Outcomes and Left Ventricular Remodeling,"
Journal of the Saudi Heart Association: Vol. 37
:
Iss.
4
, Article 9.
Available at: https://doi.org/10.37616/2212-5043.1464
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