Deepak Bhatt, MD, MPH, MBA: SGLT2 Offers Kidney Protective Benefit in Post-MI Population

New data from an analysis of the EMPACT-MI trial is shedding light on the kidney protective benefits obtained from SGLT2 inhibition among a post-myocardial infarction patient population.¹

“Our research showed that empagliflozin exhibited kidney-protective effects by reducing the decline in the eGFR (estimated glomerular filtration rate), which measures how well the kidneys are filtering waste, compared with placebo," said lead investigator Deepak Bhatt, MD, MPH, MBA, director of the Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai.² "Importantly, our data also showed that empagliflozin was safe to initiate soon after an acute MI, regardless of the patient’s baseline kidney function.”

Initially presented at ACC 2024, the EMPACT-MI trial was a double-blind, randomized, placebo-controlled study of 6522 patients who were randomized to empagliflozin or placebo within 14 days of admission for acute myocardial infarction. Primary trial results found, during a median follow-up of 17.9 months, use of empagliflozin did not significantly reduce overall heart failure hospitalizations or all-cause mortality (HR, 0.90; 95% CI, 0.76 to 1.06; P = .21). However, a significant reduction in heart failure hospitalizations was observed (HR, 0.77; 95% CI, 0.60 to 0.98).³

At the European Society of Cardiology (ESC) Congress 2024, Bhatt presented data from a prespecified analysis designed with the intent to assess the effects on outcomes in the trial with patients stratified according to baseline kidney function.¹

Results presented by Bhatt indicated there was no statistically significant difference in all-cause mortality, but a reduction in risk of hospitalization for heart failure was observed regardless of baseline kidney function within the trial. Further analysis of kidney-specific endpoints revealed empagliflozin was associated with nonsignificant trend towards benefit on incidence of first kidney disease progression or all-cause mortality, acute kidney injury, and a composite of acute kidney injury, chronic renal replacement therapy, renal transplantation, or renal death.¹

Additional analysis of kidney-specific parameters suggested use of empagliflozin was associated with a stable eGFR during the 24-month follow-up period, whereas those in the play ego group experienced a decline in eGFR (adjusted mean difference in change, 4.1; 95% CI, 0.9 to 7.3; P = .01).¹

For more on the results of the study, check out our interview with Bhatt.

Relevant disclosures for Bhatt include Amarin, AstraZeneca, Sanofi, Pfizer, Roche, Amgen, and Eli Lilly and Company, among others.

References:

1. DL Bhatt. Cardiorenal effects and safety of initiation of empagliflozin after acute myocardial infarction. Presented at: European Society of Cardiology Congress 2024. August 30 - September 2, 2024. London, UK.
2. Mount Sinai Health System. SGLT2 inhibitor Empagliflozin is shown to be safe and effective for treating patients who have suffered a heart attack. Mount Sinai Health System. September 3, 2024. Accessed September 10, 2024. https://www.mountsinai.org/about/newsroom/2024/sglt2-inhibitor-empagliflozin-is-shown-to-be-safe-and-effective-for-treating-patients-who-have-suffered-a-heart-attack.
3. Campbell P. Empagliflozin misses primary endpoint in Post-MI patient population, empact-mi trial. HCP Live. April 8, 2024. Accessed September 2, 2024. https://www.hcplive.com/view/empagliflozin-misses-primary-endpoint-in-post-mi-patient-population-empact-mi-trial.