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

• Published in: European journal of heart failure 2024-04, Vol.26 (4), p.912-924
• Main Authors: Peikert, Alexander, Vaduganathan, Muthiah, Claggett, Brian L., Kulac, Ian J., Foà, Alberto, Desai, Akshay S., Jhund, Pardeep S., Carberry, Jaclyn, Lam, Carolyn S.P., Kosiborod, Mikhail N., Inzucchi, Silvio E., Martinez, Felipe A., Boer, Rudolf A., Hernandez, Adrian F., Shah, Sanjiv J., Køber, Lars, Ponikowski, Piotr, Sabatine, Marc S., Petersson, Magnus, Langkilde, Anna Maria, McMurray, John J.V., Solomon, Scott D.
• Format: Article
• Language: English
• Subjects: Aged; Benzhydryl Compounds - therapeutic use; Disease Progression; Double-Blind Method; Female; Glucosides - administration & dosage; Glucosides - therapeutic use; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart failure with mildly reduced ejection fraction; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Humans; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - drug therapy; SGLT2 inhibitors; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stroke Volume - physiology; Treatment Outcome; Ventricular Function, Left - drug effects; Ventricular Function, Left - physiology
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1002/ejhf.3184

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; pinteraction = 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. History of myocardial infarction (MI), clinical outcomes and treatment response to dapagliflozin. Incidence rate of the primary composite outcome (first occurrence of cardiovascular [CV] death, heart failure [HF] hospitalization, or urgent HF visit) across the spectrum of left ventricular ejection fraction (LVEF) and treatment effect of dapagliflozin compared with placebo on the primary composite outcome and key secondary outcomes according to history of MI. Ci, confidence interval.