Early dapagliflozin therapy after STEMI in patients with preserved ejection fraction: a prospective cohort study
H G Hayrapetyan, V R Ter-Grigoryan, M S Sargsyan, V A Kalantaryan, F I Muradyan, I A Arakelyan, L H HayrapetyanAbstract
Background
SGLT2 inhibitors improve outcomes in patients with chronic heart failure; however, evidence supporting their early use after ST-segment elevation myocardial infarction (STEMI), particularly in patients with preserved left ventricular ejection fraction (LVEF), remains limited.
Purpose
To explore the clinical and echocardiographic outcomes associated with early dapagliflozin initiation in non-diabetic STEMI patients with preserved LVEF following primary percutaneous coronary intervention (PCI).
Methods
This prospective, non-randomized study enrolled 100 non-diabetic patients with primary STEMI, LVEF >45%, and successful primary PCI within 24 hours of symptom onset. Fifty patients received standard medical therapy (Control group), while 50 patients additionally received dapagliflozin 10 mg once daily initiated within the first 48 hours of hospitalization (Dapa group). Echocardiography was performed within 24 hours and repeated at one year. The primary endpoint was heart failure hospitalization at one year. Secondary endpoints included cardiovascular mortality, changes in LVEF, renal function, glycosylated hemoglobin levels, and safety outcomes.
Results
Baseline LVEF was similar between groups (52.1 ± 4.3% in the Dapa group vs. 52.4 ± 4.1% in controls; p=0.72). At one year, LVEF increased modestly in both groups (54.0 ± 4.6% vs. 53.6 ± 4.5%; p=0.68), with no significant difference in LVEF change between groups (Δ +1.9% vs. +1.2%; p=0.41). Heart failure hospitalization occurred in 10% of patients in the Dapa group and 12% in the control group (p=0.75). One-year cardiovascular mortality was 10% and 12%, respectively (p=0.75). Renal function, glycosylated hemoglobin levels, and adverse event rates were comparable throughout follow-up.
Conclusions
In non-diabetic STEMI patients with preserved LVEF, early dapagliflozin initiation following primary PCI was safe but did not significantly influence left ventricular systolic function, heart failure hospitalization, or cardiovascular mortality at one year. These findings suggest a neutral effect in this population and support the need for larger, adequately powered trials to define whether early SGLT2 inhibition confers benefit in selected post-MI subgroups.