Dapagliflozin in patients with heart failure and previous myocardial infarction: A participant-level pooled analysis of DAPA-HF and DELIVER.

Autor: Peikert A; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.; University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria., Vaduganathan M; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Claggett BL; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Kulac IJ; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Foà A; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Desai AS; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Jhund PS; BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK., Carberry J; BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK., Lam CSP; National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore.; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands., Kosiborod MN; Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA., Inzucchi SE; Yale School of Medicine, New Haven, CT, USA., Martinez FA; Universidad Nacional de Córdoba, Córdoba, Argentina., de Boer RA; Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands., Hernandez AF; Duke University Medical Center, Durham, NC, USA., Shah SJ; Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Køber L; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark., Ponikowski P; Department of Heart Disease, Wroclaw Medical University, Wroclaw, Poland., Sabatine MS; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Petersson M; Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden., Langkilde AM; Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden., McMurray JJV; BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK., Solomon SD; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2024 Apr; Vol. 26 (4), pp. 912-924. Date of Electronic Publication: 2024 Mar 15.
DOI: 10.1002/ejhf.3184
Abstrakt: Aims: Patients with heart failure (HF) and history of myocardial infarction (MI) face a higher risk of disease progression and clinical events. Whether sodium-glucose cotransporter 2 inhibitors may modify clinical trajectory in such individuals remains incompletely understood.
Methods and Results: The DAPA-HF and DELIVER trials compared dapagliflozin with placebo in patients with symptomatic HF with left ventricular ejection fraction (LVEF) ≤40% and > 40%, respectively. In this pooled participant-level analysis, we assessed efficacy and safety outcomes by history of MI. The primary outcome in both trials was the composite of cardiovascular death or worsening HF. Of the total of 11 007 patients, 3731 (34%) had a previous MI and were at higher risk of the primary outcome across the spectrum of LVEF in covariate-adjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02-1.24). Dapagliflozin reduced the risk of the primary outcome to a similar extent in patients with (HR 0.83, 95% CI 0.72-0.96) and without previous MI (HR 0.76, 95% CI 0.68-0.85; p interaction  = 0.36), with consistent benefits on key secondary outcomes as well. Serious adverse events did not occur more frequently with dapagliflozin, irrespective of previous MI.
Conclusion: History of MI confers increased risks of adverse cardiovascular outcomes in patients with HF across the LVEF spectrum, even among those with preserved ejection fraction. Dapagliflozin consistently and safely reduces the risk of cardiovascular death or worsening HF, regardless of previous MI.
(© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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