Cardiometabolic Outcomes with Dapagliflozin After Myocardial Infarction by Baseline Ejection Fraction: DAPA-MI
Year: 2025
Type: article
Abstract: AIMS: In the randomized DAPA-MI clinical trial, 10 mg of dapagliflozin once daily improved cardiometabolic outcomes versus placebo after acute myocardial infarction (MI) in patients without established diabetes or heart failure (HF). We assessed associations between baseline left ventricular ejection fraction (LVEF) and cardiometabolic outcomes in DAPA-MI. METHODS: The primary outcome, assessed using the win ratio method, was the hierarchical composite of death, hospitalization for HF, non-fatal MI, atrial fibrillation/flutter, Type 2 diabetes, New York Heart Association classification at last visit and body weight decrease of ≥5% from baseline to last visit. For the present analysis, patients were categorized using LVEF at randomization (<50% or ≥50%). RESULTS: Of the DAPA-MI participants with available LVEF data who received ≥1 dose of study drug (n = 3751), 2913 (77.7%) had LVEF <50% and 838 (22.3%) had LVEF ≥50%. The primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.38 (95% CI: 1.21, 1.57; P < 0.001) in patients with LVEF <50% and 1.32 (1.00, 1.73; P = 0.048) in patients with LVEF ≥ 50% (P interaction = 0.76). In a sensitivity analysis excluding patients with LVEF <30%, the primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.40 (95% CI: 1.22, 1.61; P < 0.001). There were no significant interactions between baseline LVEF and any secondary outcomes. CONCLUSIONS: Regardless of baseline LVEF, dapagliflozin resulted in significant cardiometabolic benefits versus placebo, although there was no impact on the composite of cardiovascular death or hospitalization for HF.
Source: ESC Heart Failure
DOI: 10.1002/ehf2.15420
Authors: David Erlinge, Stefan James, John Deanfield, Niclas Eriksson, Mark de Belder, Monér Alchay, David Austin, Daniel A. Jones, Annica Ravn-Fischer, Sofia Sederholm Lawesson, Nikunj Shah, Julian W. Strange, Karolina Szummer, Wilhelm Ridderstråle, Ehsan Parvaresh Rizi, Anna Maria Langkilde, Peter A. Johansson, Darren K. McGuire, Jonas Oldgren, Robert F. Storey
Institutions: Lund University, Uppsala University, University College London, Norra Älvsborgs Länssjukhus, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Newcastle University, St Bartholomew's Hospital, Queen Mary University of London, William Harvey Research Institute, Sahlgrenska University Hospital, University of Gothenburg, Linköping University, Linköping University Hospital, Queen Alexandra Hospital, University Hospitals Bristol NHS Foundation Trust, Weston Area Health NHS Trust, Karolinska University Hospital, Karolinska Institutet, AstraZeneca (Sweden), Parkland Health & Hospital System, The University of Texas Southwestern Medical Center, Sheffield Teaching Hospitals NHS Foundation Trust, NIHR Sheffield Biomedical Research Centre, University of Sheffield
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,850
Funders: AstraZeneca Mölndal, AstraZeneca
OpenAlex ID: W4414304739