학술논문
GLP-1 receptor agonists-SGLT-2 inhibitors combination therapy and cardiovascular events after acute myocardial infarction: an observational study in patients with type 2 diabetes.
Document Type
Article
Author
Marfella, Raffaele; Prattichizzo, Francesco; Sardu, Celestino; Rambaldi, Pier Francesco; Fumagalli, Carlo; Marfella, Ludovica Vittoria; La Grotta, Rosalba; Frigé, Chiara; Pellegrini, Valeria; D'Andrea, Davide; Cesaro, Arturo; Calabrò, Paolo; Pizzi, Carmine; Antonicelli, Roberto; Ceriello, Antonio; Mauro, Ciro; Paolisso, Giuseppe
Source
Subject
*PRASUGREL
*MYOCARDIAL infarction
*TYPE 2 diabetes
*SINGLE-photon emission computed tomography
*GLUCAGON-like peptide-1 receptor
*MAJOR adverse cardiovascular events
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Language
ISSN
1475-2840
Abstract
Background: Few studies explored the effect of the combination of glucose sodium-cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on the incidence of cardiovascular events in patients with type 2 diabetes (T2D) and acute myocardial infarction (AMI). Methods: We recruited patients with T2D and AMI undergoing percutaneous coronary intervention, treated with either SGLT-2i or GLP-1RA for at least 3 months before hospitalization. Subjects with HbA1c < 7% at admission were considered in good glycemic control and maintained the same glucose-lowering regimen, while those with poor glycemic control (HbA1c ≥ 7%), at admission or during follow-up, were prescribed either a SGLT-2i or a GLP-1RA to obtain a SGLT-2i/GLP-1RA combination therapy. The primary outcome was the incidence of major adverse cardiovascular events (MACE) defined as cardiovascular death, re-acute coronary syndrome, and heart failure related to AMI during a 2-year follow-up. After 3 months, the myocardial salvage index (MSI) was assessed by single-photon emission computed tomography. Findings: Of the 537 subjects screened, 443 completed the follow-up. Of these, 99 were treated with SGLT-2i, 130 with GLP-1RA, and 214 with their combination. The incidence of MACE was lower in the combination therapy group compared with both SGLT-2i and GLP-1RA treated patients, as assessed by multivariable Cox regression analysis adjusted for cardiovascular risk factors (HR = 0.154, 95% CI 0.038–0.622, P = 0.009 vs GLP-1RA and HR = 0.170, 95% CI 0.046–0.633, P = 0.008 vs SGLT-2i). The MSI and the proportion of patients with MSI > 50% was higher in the SGLT-2i/GLP-1RA group compared with both SGLT-2i and GLP-1RA groups. Interpretation: The combination of SGLT-2i and GLP-1RA is associated with a reduced incidence of cardiovascular events in patients with T2D and AMI compared with either drug used alone, with a significant effect also on peri-infarcted myocardial rescue in patients without a second event. Trial registraition ClinicalTrials.gov ID: NCT06017544. [ABSTRACT FROM AUTHOR]