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Dapagliflozin improves cardiometabolic outcomes in MI

Presented by
Prof. Stefan James, Uppsala University, Sweden
AHA 2023
Phase 3, DAPA-MI
Dapagliflozin demonstrated a positive benefit on cardiometabolic outcomes in patients with acute myocardial infarction (MI) and impaired left ventricular (LV) systolic function who did not have diabetes or chronic heart failure (HF). No differences were seen in cardiovascular outcomes.

The registry-based, double-blind, randomised, phase 3 DAPA-MI trial (NCT04564742) aimed to test the effect of dapagliflozin on cardiometabolic and cardiovascular outcomes in patients with acute MI but without diabetes or chronic HF [1]. Patients who had had a non-STEMI or STEMI in the last 10 days were eligible for enrollment in the trial.

The 4,017 participants were randomised 1:1 to the SGLT2 inhibitor dapagliflozin, 10 mg once daily, or placebo. The primary endpoint was a hierarchical composite outcome of death, hospitalisation for HF, non-fatal MI, atrial fibrillation, new diagnosis of type 2 diabetes, NYHA functional class status, and body weight decrease of at least 5%. “Importantly, this study population was very well treated according to guideline directions,” emphasised Prof. Stefan James (Uppsala University, Sweden), who presented the findings.

The primary outcome showed a win ratio of 1.34 in favour of participants in the dapagliflozin arm (95% CI 1.20–1.50; P<0.001). The corresponding win percentages were 32.9% in favour of dapagliflozin, 24.6% in favour of placebo, and 42.5% ties. “When we look more closely at the components of the primary outcome, we can see that the effect is driven by cardiometabolic outcomes, such as diabetes diagnosis and body weight reduction, rather than cardiovascular outcomes,” added Prof. James.

In conclusion, dapagliflozin, on top of guideline-directed medical therapy offered benefits for patients with acute MI and impaired LV systolic function who did not have diabetes or chronic HF.

    1. James S, et al. Dapagliflozin in myocardial infarction without diabetes or heart failure. LB02, AHA Scientific Sessions 2023, 10–12 November, Philadelphia, USA.


Medical writing support was provided by Robert van den Heuvel.
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