A secondary analysis of the EMPACT-MI trial, published in Nature Cardiovascular Research, showed that the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin stabilized kidney function and reduced heart failure hospitalizations in patients who have recently experienced a heart attack.
Researchers randomized 6,522 patients who were hospitalized for acute myocardial infarction (heart attack) to receive either empagliflozin or placebo, starting on average 5 days after the event. Patients were followed for approximately 18 months. The trial included patients regardless of their diabetes or chronic kidney disease status.
The investigators found that empagliflozin preserved kidney function over 2 years, as measured by estimated glomerular filtration rate (eGFR), while patients on placebo experienced significant kidney function decline. Specifically, the difference in eGFR change between groups was 4.1 ml/min/1.73 m², favoring empagliflozin. Additionally, empagliflozin reduced total hospitalizations for heart failure by 33% compared with placebo (2.4 vs 3.6 events per 100 person-years), and consistent benefits were observed across different levels of kidney function.
These findings address concerns about the safety of initiating SGLT2 inhibitors shortly following a heart attack, particularly in patients with impaired kidney function. The results suggest that clinicians should not withhold empagliflozin from eligible patients due to fears of kidney harm.
Lead investigator Deepak L. Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital, stated, “SGLT2 inhibitors are underused in clinical practice. These data provide reassurance of the safety of using this class of drugs when indicated – even in patients after a recent heart attack and if the kidney function is impaired.”
The EMPACT-MI trial (NCT04509674) was a multicenter, randomized, double-blind, placebo-controlled study that was conducted across 22 countries. It was funded by Boehringer Ingelheim in partnership with the Duke Clinical Research Institute.
Disclosures: The study was funded by Boehringer Ingelheim and Lilly. Disclosures are available in the original publication.
Source: Nature Cardiovascular Research