Infarct size, inflammatory burden, and admission hyperglycemia in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: a multicenter international registry

• Published in: Cardiovascular diabetology Vol. 21; no. 1; pp. 77 - 12
• Main Authors: Paolisso, Pasquale, Bergamaschi, Luca, Santulli, Gaetano, Gallinoro, Emanuele, Cesaro, Arturo, Gragnano, Felice, Sardu, Celestino, Mileva, Niya, Foà, Alberto, Armillotta, Matteo, Sansonetti, Angelo, Amicone, Sara, Impellizzeri, Andrea, Casella, Gianni, Mauro, Ciro, Vassilev, Dobrin, Marfella, Raffaele, Calabrò, Paolo, Barbato, Emanuele, Pizzi, Carmine
• Format: Journal Article
• Language: English
• Published: England BioMed Central 15.05.2022; BMC
• Subjects: Acute coronary syndromes; Acute myocardial infarction; Biomarkers; Blood glucose; Blood Glucose - metabolism; C-reactive protein; Calcium-binding protein; Cardiovascular disease; Coronary artery; Coronary vessels; Creatinine; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Echocardiography; Glucose; Glucose transporter; Heart attacks; Heart diseases; Heart surgery; Humans; Hyperglycemia; Hyperglycemia - epidemiology; Infarct size; Inflammation; Insulin; Ischemia; Leukocytes (neutrophilic); Lymphocytes; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - drug therapy; Myocardial Infarction - epidemiology; Neutrophils; Patients; Percutaneous Coronary Intervention - adverse effects; Platelets; Population; Population studies; Registries; SGLT2-I; Sodium-Glucose Transporter 2; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Troponin; Troponin - metabolism; Values; SGLT2-I; Infarct size; Hyperglycemia; Inflammation; Acute myocardial infarction
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-022-01506-8

The inflammatory response occurring in acute myocardial infarction (AMI) has been proposed as a potential pharmacological target. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) currently receive intense clinical interest in patients with and without diabetes mellitus (DM) for their pleiotropic beneficial effects. We tested the hypothesis that SGLT2-I have anti-inflammatory effects along with glucose-lowering properties. Therefore, we investigated the link between stress hyperglycemia, inflammatory burden, and infarct size in a cohort of type 2 diabetic patients presenting with AMI treated with SGLT2-I versus other oral anti-diabetic (OAD) agents. In this multicenter international observational registry, consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled. Based on the presence of anti-diabetic therapy at the admission, patients were divided into those receiving SGLT2-I (SGLT-I users) versus other OAD agents (non-SGLT2-I users). The following inflammatory markers were evaluated at different time points: white-blood-cell count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), and C-reactive protein. Infarct size was assessed by echocardiography and by peak troponin levels. The study population consisted of 583 AMI patients (with or without ST-segment elevation): 98 SGLT2-I users and 485 non-SGLT-I users. Hyperglycemia at admission was less prevalent in the SGLT2-I group. Smaller infarct size was observed in patients treated with SGLT2-I compared to non-SGLT2-I group. On admission and at 24 h, inflammatory indices were significantly higher in non-SGLT2-I users compared to SGLT2-I patients, with a significant increase in neutrophil levels at 24 h. At multivariable analysis, the use of SGLT2-I was a significant predictor of reduced inflammatory response (OR 0.457, 95% CI 0.275-0.758, p = 0.002), independently of age, admission creatinine values, and admission glycemia. Conversely, peak troponin values and NSTEMI occurrence were independent predictors of a higher inflammatory status. Type 2 diabetic AMI patients receiving SGLT2-I exhibited significantly reduced inflammatory response and smaller infarct size compared to those receiving other OAD agents, independently of glucose-metabolic control. Our findings are hypothesis generating and provide new insights on the cardioprotective effects of SGLT2-I in the setting of coronary artery disease. Data are part of the ongoing observational registry: SGLT2-I AMI PROTECT. gov Identifier: NCT05261867.