Dapagliflozin may be effective for preventing left ventricular (LV) dysfunction and maintaining cardiac function after anterior ST-elevation myocardial infarction (STEMI), according to a study in the International Journal of Cardiology.
Investigators sought to determine whether early administration of dapagliflozin immediately following anterior STEMI would have favorable outcomes for cardiac function.
The prospective, double-blinded, randomized DACAMI (Dapagliflozin on Cardiac Function Following Anterior Myocardial Infarction; ClinicalTrials.gov Identifier: NCT05424315) trial was conducted in Cairo, Egypt. Eligible participants were admitted with anterior STEMI, had echocardiographic evidence of reduced LV ejection fraction (LVEF) of less than 50%, and had successful reperfusion with primary percutaneous coronary angiography (pPCI). Patients with diabetes mellitus types 1 and 2 and those previously diagnosed with heart failure were excluded.
The participants were allocated in a 1:1 ratio into a study group or a control group. The study group received dapagliflozin 10 mg once daily plus guideline-directed medical treatment (GDMT), and the control group received placebo plus GDMT. In the study group, participants received dapagliflozin commencing no later than 72 hours after successful pPCI for STEMI.
The primary outcomes were change in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels from baseline to 12 weeks post-anterior STEMI and/or change in LVEF, end-diastolic volume, and/or LV mass index (LVMI) assessed with transthoracic echocardiography at baseline and 4 and 12 weeks post-anterior STEMI.
A total of 100 patients were included from October 2021 to April 2022, 50 patients in the study group and 50 in the control group. The study group had a mean age of 55.24±13.2 years (84% men), and the placebo group had a mean age of 56.70±11.5 years (82% men).
No patients in the study group had a genitourinary infection or hypoglycemic episode. During the 12-week follow-up, 2 patients in either group were hospitalized for heart failure and no mortality occurred.
Baseline median NT-proBNP levels were 290.8 ng/L (IQR, 104.7-387.2) in the study group and 289.4 ng/L (IQR, 92.5-378.6) in the control group (P =.891).
At 12 weeks, the mean reduction in NT-proBNP level was significantly lower for the study group vs the control group by 10.17% (95% CI, -3.28 to 19.67, P =.034).
The study group had a significantly greater change in LVMI vs the control group at 4 and 12 weeks. As early as 4 weeks, LVMI in the study group was less than that in the control group by 7.07% (95% CI, -9.84 to -4.3; P =.032). At 12 weeks, LVMI in the study group was less than that in the control group by 11.46% (95% CI, -19.37 to -3.56; P = .029).
Limitations of the study include the small sample size and that patients were only enrolled from 2 centers. Also, the study depended on objective biomarkers and echocardiographic parameters to derive results, and it is unknown whether this translates into less morbidity and mortality in the future.
“…early administration of dapagliflozin proved to have favorable outcomes on cardiac function, as evidenced by a significant drop in NT-proBNP levels and a significant decrease in LV mass index in the study group compared to the control group,” the investigators wrote.
Disclosure: The NT-proBNP ELISA kits were provided by Inspire Pharma. Please see the original reference for a full list of disclosures.
Dayem KA, Younis O, Zarif B, Attia S, AbdelSalam A. Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients – DACAMI (a randomized controlled clinical trial). Int J Cardiol. Published online March 6, 2023. doi: 10.1016/j.ijcard.2023.03.002