| BackgroundIt is estimated that more than 415 million adults worldwide have diabetes,and the rate is still rising,and more than 600 million people are expected to have diabetes mellitus by 2035[1].Diabetic patients are prone to various serious complications,among which cardiovascular disease(CVD)is the leading cause of death for them[2].Studies have shown that,compared with non-diabetic patients,the incidences of stent restenosis and major cardiovascular adverse events(MACE)after percutaneous coronary intervention(PCI)are higher in diabetic patients,with poor treatment effects and prognoses[3].At present,some hypoglycemic drugs may even have an adverse effect on the cardiovascular outcomes of diabetic patients[4],and the options of hypoglycemic drugs for patients with diabetes complicated with CVD are limited.Therefore,It is important to explore treatments for diabetes that effectively reduce cardiovascular risk.Dapagliflozin is a novel hypoglycemic agent,which can effectively reduce the level of glycosylated hemoglobin in patients by selectively inhibiting sodium-glucose co-transporter 2(SGLT-2).Clinical studies have demonstrated that dapagliflozin had pleiotropic effects in addition to hypoglycemic,resulted in sustained reductions in body weight,blood pressure and serum uric acid levels and can also delay the deterioration of renal function.A number of large randomized controlled clinical trials have proved cardiovascular benefits of SGLT-2 inhibitor in diabetic patients with atherosclerotic cardiovascular diseases(ASCVD)[5-7].The European Society of Cardiology(ESC)/European Association for the Study of Diabetes(EASD)2019 guidelines recommend SGLT-2 inhibitors as first line agents in patients with type 2 diabetes(T2DM)and ASCVD or high cardiovascular risk[8].However,the cardiovascular effects of SGLT-2 inhibitors on patients with coronary heart disease after PCI are unknown.In this study,we evaluated the effects of dapagliflozin on cardiovascular outcomes in patients with unstable angina pectoris(UA)and diabetes after PCI,compared to standard treatment.ObjectiveTo investigate the effects of dapagliflozin on cardiovascular outcomes in patients with UA and T2DM after PCI.MethodThis is a retrospective study,and a total of 187 patients with UA and T2DM after PCI admitted to the First Affiliated Hospital of Zhengzhou University from June 2018 to June 2019 were selected.They were divided into 2 groups:dapagliflozin group(n=91)and control group(n=96)according to different medications.(1)dapagliflozin group:taking 10 mg dapagliflozin or in combination with other hypoglycemic drugs every day;(2)control group:other hypoglycemic drugs except SGLT-2 inhibitors were applied.Each patient's age,gender,history of diabetes,smoking history and other related medical history were recorded at baseline.Body mass index,(BMI),blood pressure,glycosylated hemoglobin(HbA1c),serum uric acid,estimated glomerular filtration rate(eGFR),N-terminal brain natriuretic peptide(NT-proBNP),blood lipids,left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)were recorded at baseline and 6 months after admission,respectively.Patients were classified according to Braunwald criteria.The Gensini score was calculated.The primary outcome is MACE,the composite of hospitalization for heart failure(HHF)or for unstable angina.MACE defined as cardiac death,myocardial infarction or stroke.The last follow-up date was December 31,2019.SPSS 23.0 software package was used for statistical analysis.The measurement data conforming to the normal distribution were represented by mean±standard deviation(X±S),while the non-normal distribution measurement data were represented by the median and quartile spacing(P25,P75).The two groups was compared by the t-est or rank-sum test Enumeration data were expressed as cases(%),?2-tests were used to compare two groups.The two outcomes of MACE and the composite of hospitalization for heart failure or or for unstable angina were analyzed by Kaplan-Meier method.And the survival difference between two groups was analyzed by Log-rank method.P<0.05 was considered statistically significant.Result1.Mean age of the 187 patients with UA and T2DM after PCI was 62.37 years.There were no significant differences in baseline characteristics between the two groups(P<0.05).2.After 6 months of treatment,compared with the control group,cardiovascular risk factors including the weight(P<0.001),blood pressure(P=0.001),HbA1c(P=0.017),serum uric acid(P=0.042)group were improved in the dapagliflozin,with statistically significant differences.3.Compared with the baseline,NT-proBNP(P<0.001)decreased,both LVEDD(P=0.171)and LVEF(P=0.083)showed no significant differences.There was no difference in NT-proBNP(P=0.487)before and after treatment in control group.After 6 months of treatment,NT-proBNP(P<0.001)in dapagliflozin group was lower than that in control group,and there was no difference in LVEF(P=0.096)and LVEDD(P=0.059).4.The incidence of MACE(P=0.652),the hospitalization for heart failure or for unstable angina pectoris((P=0.314)were not significantly different between two groups.The study involved 187 patients who were followed for a median of 364 days.The log-survival function of hospitalization events was fitted by Kaplan-Meier method,and the hospitalization for heart failure or for unstable angina pectoris in the dapagliflozin group was lower than that in the control group(Log Rank test,?2=4.169,P=0.041).5.There was no significant difference in the incidence of drug-related adverse events such as genitourinary infection(P=0.680),non-traumatic amputation(P=0.487),hypoglycemia(P=0.952)and diabetic ketoacidosis(DKA)(P=0.630)between the two groups.ConclusionIn patients with UA and T2DM after PCI,dapagliflozin decreased the incidence of hospitalization for heart failure or for unstable angina without increased adverse reactions. |
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