Dapagliflozin Effects in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The DAPA-STEMI Randomized Clinical Trial

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BACKGROUND: Acute myocardial infarction (MI) is associated with a high incidence of morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are antidiabetic medications known for their favorable effects on cardiovascular disease. However, evidence regarding their effects in acute MI is limited. STUDY QUESTION: Whether early administration of dapagliflozin could affect the cardiovascular outcome of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). STUDY DESIGN: We randomly allocated 101 patients with nondiabetes, nonheart failure STEMI undergoing primary PCI to receive dapagliflozin (10 mg/d started before PCI and continued for 40 days) or placebo. MEASURES AND OUTCOMES: The primary outcomes were changes in left ventricular ejection fraction (LVEF) 40 days after PCI, changes in cardiac troponin I (cTnI) levels, estimated infarct size using the peak and area under the curve (AUC) of cTnI, and ST-segment resolution. Secondary outcomes included high-sensitivity C-reactive (hs-CRP) protein levels at discharge and health-related quality of life (HRQoL) 40 days after acute MI. RESULTS: The results revealed a significant increase in LVEF in dapagliflozin-treated patients with baseline LVEF ≤40% compared with the placebo group (41.1 ± 5.5 vs. 38.1 ± 6.9; P = 0.037). No significant difference was observed regarding ST-segment resolution, cTnI levels, AUC, and peak between the 2 groups. We did not observe a significant difference regarding secondary outcomes. CONCLUSIONS: This study showed that dapagliflozin could significantly improve LVEF among patients whose LVEF dropped to ≤40% post-STEMI. However, further studies are required to confirm the study findings.

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