In-hospital arrhythmic burden reduction in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: Insights from the SGLT2-I AMI PROTECT study

Abstract

BackgroundSodium-glucose co-transporter 2 inhibitors (SGLT2-i) have shown significant cardiovascular benefits in patients with and without type 2 diabetes mellitus (T2DM). They have also gained interest for their potential anti-arrhythmic role and their ability to reduce the occurrence of atrial fibrillation (AF) and ventricular arrhythmias (VAs) in T2DM and heart failure patients.ObjectivesTo investigate in-hospital new-onset cardiac arrhythmias in a cohort of T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-i vs. other oral anti-diabetic agents (non-SGLT2-i users).MethodsPatients from the SGLT2-I AMI PROTECT registry (NCT05261867) were stratified according to the use of SGLT2-i before admission for AMI, divided into SGLT2-i users vs. non-SGLT2-i users. In-hospital outcomes included the occurrence of in-hospital new-onset cardiac arrhythmias (NOCAs), defined as a composite of new-onset AF and sustained new-onset ventricular tachycardia (VT) and/or ventricular fibrillation (VF) during hospitalization.ResultsThe study population comprised 646 AMI patients categorized into SGLT2-i users (111 patients) and non-SGLT2-i users (535 patients). SGLT2-i users had a lower rate of NOCAs compared with non-SGLT2-i users (6.3 vs. 15.7%, p = 0.010). Moreover, SGLT2-i was associated with a lower rate of AF and VT/VF considered individually (p = 0.032). In the multivariate logistic regression model, after adjusting for all confounding factors, the use of SGLT2-i was identified as an independent predictor of the lower occurrence of NOCAs (OR = 0.35; 95%CI 0.14–0.86; p = 0.022). At multinomial logistic regression, after adjusting for potential confounders, SGLT2-i therapy remained an independent predictor of VT/VF occurrence (OR = 0.20; 95%CI 0.04–0.97; p = 0.046) but not of AF occurrence.ConclusionsIn T2DM patients, the use of SGLT2-i was associated with a lower risk of new-onset arrhythmic events during hospitalization for AMI. In particular, the primary effect was expressed in the reduction of VAs. These findings emphasize the cardioprotective effects of SGLT2-i in the setting of AMI beyond glycemic control.Trial registrationData are part of the observational international registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov, identifier: NCT05261867.

The Therapeutic Role of SGLT-2 Inhibitors in Acute Heart Failure: From Pathophysiologic Mechanisms to Clinical Evidence with Pooled Analysis of Relevant Studies across Safety and Efficacy Endpoints of Interest

“…However, SGLT-2 inhibitors do not affect the risk for ventricular arrhythmias and sudden cardiac death, as reported in another recently published meta-analysis [52]. In the acute setting of myocardial infarction, it was recently demonstrated that prior use of SGLT-2 inhibitors among the affected subjects resulted in significantly lower rates of atrial fibrillation, ventricular tachycardia and ventricular fibrillation, while SGLT-2 inhibitor use was associated with a significant reduction in the odds for new-onset arrhythmia during hospitalization by 65% [53].…”

ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute ST-segment elevation myocardial infarction

“…Furthermore, malignant outcomes are worse if VT/VF occurs late instead of early [5,11]. Fortunately, the recent investigation shows the use of sodium-glucose co-transporter 2 inhibitors (SGLT2-i) was associated with a lower risk of new-onset arrhythmic events, especially VT/VF, during hospitalization and long-term follow-up for AMI patients complicated T2DM [14,15]. Therefore, the difference in the effect of VT/VF on the prognosis of STEMI shows the varied electrophysiological mechanisms of VT/VF.…”

Association of inflammation indices with left atrial thrombus in patients with valvular atrial fibrillation

“…Furthermore, it was reported that the NLR could be reduced by anti-inflammatory therapy using canakinumab [ 20 ]. Another promising pharmacological agent, sodium-glucose cotransporter 2 inhibitor, could also decrease the level of NLR by directly targeting inflammatory pathways such as nucleotide-binding domain-like receptor protein-3 inflammasome [ 21 , 22 ]. Recent evidence suggested that inflammation indices could identify high-risk patients with thromboembolic diseases such as acute pulmonary embolism or peripheral arterial disease [ 23 , 24 ].…”