Sodium-glucose Cotransporter-2 Inhibitors Stabilize Coronary Plaques in Acute Coronary Syndrome with Diabetes Mellitus

Link to article at PubMed

Am J Cardiol. 2024 Jan 10:S0002-9149(24)00025-0. doi: 10.1016/j.amjcard.2023.12.056. Online ahead of print.


Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are widely used in cardiology and are effective in treating acute coronary syndrome (ACS). Their effects on unstable plaque in ACS patients remains unclear. This study aimed to examine the effectiveness of SGLT2i in coronary plaque based on optical coherence tomography (OCT) images and the prognosis of ACS with type 2 diabetes mellitus (T2DM). This retrospective study included 109 patients in the total cohort and 29 patients in the OCT cohort. Based on SGLT2i administration after ACS, the total cohort was categorized into non-SGLT2i (n = 69) and SGLT2i (n = 40) groups. The OCT cohort had 15 and 14 patients in non-SGLT2i and SGLT2i groups, respectively. OCT images of unstable plaque were analyzed in non-stented lesions during ACS catheterization and at 6-month follow-ups. The total cohort was assessed after 1 year for major adverse cardiovascular events (MACE), including all-cause mortality, revascularization, cerebrovascular disease, and heart failure hospitalization. SGLT2i improved unstable lesions with a significantly thicker fibrous cap (48 ± 15 μm vs. 26 ± 24 μm, p=0.005), reduced lipid arc (-29 ± 12° vs. -18 ± 14°, p=0.028), and higher % decrease in total lipid arc (-35 ± 13% vs. -19 ± 18%, p=0.01) as well as a lower MACE incidence (Log rank p=0.023, hazard ratio 4.72 [1.08, 20.63]) and revascularization rate (adjusted hazard ratio 6.77 [1.08, 42.52]) compared to the non-SGLT2i group. In conclusion, SGLT2i can improve markers of plaque stability and may improve prognosis in patients with T2DM.

PMID:38215815 | DOI:10.1016/j.amjcard.2023.12.056

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