Empagliflozin attenuates neointimal hyperplasia after drug-eluting-stent implantation in patients with type 2 diabetes

• Published in: Heart and vessels 2020-10, Vol.35 (10), p.1378-1389
• Main Authors: Hashikata, Takehiro, Ikutomi, Masayasu, Jimba, Takahiro, Shindo, Akito, Kakuda, Nobutaka, Katsushika, Susumu, Yokoyama, Masaaki, Kishi, Mikio, Sato, Takahiro, Matsushita, Masashiro, Ohnishi, Satoshi, Yamasaki, Masao
• Format: Article
• Language: English
• Subjects: Aged; Antidiabetics; Attenuation; Benzhydryl Compounds - therapeutic use; Biomedical Engineering and Bioengineering; Blood pressure; Body mass; Body mass index; Body size; Cardiac Surgery; Cardiology; Cardiovascular disease; Coronary artery; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - drug effects; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Drug delivery; Drug-Eluting Stents; Female; Glucose; Glucose transporter; Glucosides - therapeutic use; Heart diseases; Hematocrit; Humans; Hyperplasia; Implantation; Implants; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Neointima; Optical Coherence Tomography; Original Article; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Prospective Studies; Regression analysis; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stents; Surgical implants; Therapy; Thickness; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-020-01621-0

The effects of empagliflozin, a sodium-glucose co-transporter 2 inhibitor, on neointimal response after drug-eluting-stent (DES) implantation remains unknown. Insufficiently controlled diabetes patients with coronary artery disease planned for DES stenting were consecutively enrolled. The patients were assigned to receive empagliflozin in addition to standard therapy or intensive therapy using other glucose-lowering drugs (oGLD). The primary endpoint was thickness of neointimal hyperplasia (NIH) 12 months after stenting assessed by optical coherence tomography (OCT). A total of 28 patients were analyzed ( n  = 15 in the empagliflozin group, n  = 13 in the oGLD group). The levels of glucose profile were not significantly different between both groups at follow-up [HbA1c; 7.2 ± 0.8 vs 7.3 ± 0.9%, p  = 0.46]. In OCT analysis, neointima was significantly less in the empagliflozin group than the oGLD group [mean NIH thickness: 137 ± 32 vs 168 ± 39 μm, p  = 0.02]. Changes of systolic and diastolic blood pressure (BP), changes of body mass index, and changes of hematocrit after additional treatment were significantly associated with NIH attenuation, whereas no correlation was observed in changes in blood glucose parameters. Multivariate logistic regression analysis revealed that changes in systolic BP was the strongest predictor for NIH attenuation, followed by changes in diastolic BP. In patients with type 2 diabetes, standard plus empagliflozin attenuated neointimal progression as compared with intensive standard therapy after DES implantation. Our data possibly support a beneficial effect of empagliflozin in type 2 diabetes required for coronary revascularization therapy.