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Cardiometabolic outcomes with dapagliflozin after myocardial infarction by baseline ejection fraction : DAPA-MI

Erlinge, David LU orcid ; James, Stefan ; Deanfield, John ; Eriksson, Niclas ; de Belder, Mark ; Alchay, Monér ; Austin, David ; Jones, Daniel A. ; Ravn-Fischer, Annica and Sederholm Lawesson, Sofia , et al. (2025) In ESC Heart Failure
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... (More)

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.

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publishing date
type
Contribution to journal
publication status
epub
subject
keywords
dapagliflozin, heart failure, left ventricular ejection fraction, myocardial infarction, sodium–glucose cotransporter-2 inhibitors
in
ESC Heart Failure
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:40958495
  • scopus:105016323509
ISSN
2055-5822
DOI
10.1002/ehf2.15420
language
English
LU publication?
yes
id
6bbb83aa-7351-4dbb-b203-2b7be9f4a5d2
date added to LUP
2025-11-11 11:58:33
date last changed
2025-11-12 03:00:06
@article{6bbb83aa-7351-4dbb-b203-2b7be9f4a5d2,
  abstract     = {{<p>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 (&lt;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 &lt;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 &lt; 0.001) in patients with LVEF &lt;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 &lt;30%, the primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.40 (95% CI: 1.22, 1.61; P &lt; 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.</p>}},
  author       = {{Erlinge, David and James, Stefan and Deanfield, John and Eriksson, Niclas and de Belder, Mark and Alchay, Monér and Austin, David and Jones, Daniel A. and Ravn-Fischer, Annica and Sederholm Lawesson, Sofia and Shah, Nikunj and Strange, Julian W. and Szummer, Karolina and Ridderstråle, Wilhelm and Parvaresh Rizi, Ehsan and Langkilde, Anna Maria and Johansson, Peter A. and McGuire, Darren K. and Oldgren, Jonas and Storey, Robert F.}},
  issn         = {{2055-5822}},
  keywords     = {{dapagliflozin; heart failure; left ventricular ejection fraction; myocardial infarction; sodium–glucose cotransporter-2 inhibitors}},
  language     = {{eng}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{ESC Heart Failure}},
  title        = {{Cardiometabolic outcomes with dapagliflozin after myocardial infarction by baseline ejection fraction : DAPA-MI}},
  url          = {{http://dx.doi.org/10.1002/ehf2.15420}},
  doi          = {{10.1002/ehf2.15420}},
  year         = {{2025}},
}