Long-term effect of empagliflozin and dapagliflozin in patients with heart failure undergoing coronary artery surgery/endovascular intervention: Is there a difference between these two SGLT2i on hospitalization, MACE, and mortality?
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Abstract
Long-term effect of empagliflozin and dapagliflozin in patients with heart failure undergoing coronary artery surgery/endovascular intervention: Is there a difference between these two SGLT2i on hospitalization, MACE, and mortality? Objective This study aims to compare the long-term effects of these two Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i) on hospitalization, major adverse cardiovascular events (MACE), and mortality in heart failure patients undergoing coronary artery bypass graft surgery (CABG)/percutaneous coronary intervention (PCI) on empagliflozin and dapagliflozin. Methods 567 patients with heart failure undergoing CABG/PCI between 2014 and 2022 were studied, and 470 patients on empagliflozin and dapagliflozin were analyzed. The two groups of patients with preserved ejection fraction (HFpEF, n= 293) and patients with low/slightly reduced ejection fraction (HFdEF, n= 177) were analyzed in two subgroups: empagliflozin and dapagliflozin users. In addition to hospitalization, MACE and mortality, age, gender, disease history, and laboratory parameters were compared. Patients with (n=123) and without (n=347) cardiac MACE were also compared. Results No significant difference was found between the groups in terms of age, HbA1c, creatinine levels, and other cardiovascular risk factors. Similar results were obtained in terms of overall mortality, cardiac mortality, MACE, cardiac MACE, and hospitalization. In the HFpEF group comparing dapagliflozin with empagliflozin, overall mortality (17.1% vs. 19.9%, p=0.544), cardiac mortality (10.5% vs. 20%, p=0.341), MACE (29. 6% vs. 26.2%, p=0.522), cardiac MACE (28.3% vs 25.5%, p=0.595) and hospitalization (27% vs 22.7%, p=0.398). Similarly, in the HFrEF group, there was no difference in overall mortality (25.9% vs. 13.8%, p= 0.054), cardiac mortality (15.2% vs. 9.2%, p= 0.246), MACE (31.3% vs 20%, p= 0. 105), cardiac MACE (28.6% vs 18.5%, p= 0.134) and hospitalization (28.6% vs. 18.5%, p= 0.134) were similar between the two SGLT2i. NT-proBNP (1451.38±2769.36 vs. 3052.30±3779.04, p< 0.001) and creatinine (0.98±0.38 vs. 1.12±0.87, p= 0.022) levels were significantly higher in the group with cardiac MACE. Conclusion Empagliflozin and dapagliflozin did not show a significant difference in their long-term effects on hospitalization, MACE, and mortality in patients with heart failure undergoing coronary artery surgery/endovascular intervention. Larger and multicentre studies are required to confirm these findings.
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Abstract
Long-term effect of empagliflozin and dapagliflozin in patients with heart failure undergoing coronary artery surgery/endovascular intervention: Is there a difference between these two SGLT2i on hospitalization, MACE, and mortality?
Objective
This study aims to compare the long-term effects of these two Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i) on hospitalization, major adverse cardiovascular events (MACE), and mortality in heart failure patients undergoing coronary artery bypass graft surgery (CABG)/percutaneous coronary intervention (PCI) on empagliflozin and dapagliflozin.
Methods
567 patients with heart failure undergoing CABG/PCI between 2014 and 2022 were studied, and 470 patients on empagliflozin and dapagliflozin were analyzed. The two groups of patients with preserved ejection fraction (HFpEF, n= 293) and patients with low/slightly reduced ejection fraction (HFdEF, n= 177) were analyzed in two subgroups: empagliflozin and dapagliflozin users. In addition to hospitalization, MACE and mortality, age, gender, disease history, and laboratory parameters were compared. Patients with (n=123) and without (n=347) cardiac MACE were also compared.
Results
No significant difference was found between the groups in terms of age, HbA1c, creatinine levels, and other cardiovascular risk factors. Similar results were obtained in terms of overall mortality, cardiac mortality, MACE, cardiac MACE, and hospitalization.
In the HFpEF group comparing dapagliflozin with empagliflozin, overall mortality (17.1% vs. 19.9%, p=0.544), cardiac mortality (10.5% vs. 20%, p=0.341), MACE (29. 6% vs. 26.2%, p=0.522), cardiac MACE (28.3% vs 25.5%, p=0.595) and hospitalization (27% vs 22.7%, p=0.398).
Similarly, in the HFrEF group, there was no difference in overall mortality (25.9% vs. 13.8%, p= 0.054), cardiac mortality (15.2% vs. 9.2%, p= 0.246), MACE (31.3% vs 20%, p= 0. 105), cardiac MACE (28.6% vs 18.5%, p= 0.134) and hospitalization (28.6% vs. 18.5%, p= 0.134) were similar between the two SGLT2i.
NT-proBNP (1451.38±2769.36 vs. 3052.30±3779.04, p< 0.001) and creatinine (0.98±0.38 vs. 1.12±0.87, p= 0.022) levels were significantly higher in the group with cardiac MACE.
Conclusion
Empagliflozin and dapagliflozin did not show a significant difference in their long-term effects on hospitalization, MACE, and mortality in patients with heart failure undergoing coronary artery surgery/endovascular intervention. Larger and multicentre studies are required to confirm these findings.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
The author(s) received no specific funding for this work.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The study received approval from the Bakırköy Dr. Sadi Konuk Training and Research Hospital Ethics Comitee (Research Protocol nNumber: 2025/02, Decision Number: 25-01-06).
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data Availability
There is no limitation. But, the data may be kept in a public repository and only available after acceptance. The authors' contact numbers, DOIs, etc. If additional information is requested, I kindly request that I be informed about this issue.
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