Incretin therapy may benefit patients with diabetes and STEMI

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Takeaway

  • Incretin therapy may be optimal for patients with type 2 diabetes (T2D) and ST elevation myocardial infarction-multivessel nonobstructive coronary stenosis (STEMI-Mv-NOCS).

Why this matters

  • Few data guide management of patients with T2D with STEMI-Mv-NOCS.

Study design

  • Prospective study of 1061 consecutive patients with first STEMI-Mv-NOCS (20%-49% luminal stenosis) undergoing coronary angiography.
  • Of 292 with diabetes, 122 used incretins (26 used glucagon-like peptide-1 receptor agonist and 96 dipeptidyl peptidase-4 inhibitor; mean treatment duration, 27 months).
  • 67 incretin users matched to 67 nonusers.
  • Primary endpoint: all-cause and cardiac deaths, and major adverse cardiac events (MACEs) at 12 months.
  • Funding: RicercaAteneo fund.

Key results

  • All-cause deaths at 1 year in 2.2% patients with diabetes vs 1.1% without (P=.05), and cardiac deaths in 1.6% vs 0.5%, respectively (P=.045).
  • MACE in 12.9% with diabetes vs 5.9% without (P<.01).  
  • In the diabetes group, MACE occurred in 7.4% of incretin users vs 12.9% of nonusers (P=.04).
  • In risk-adjusted analysis, the diabetes group had approximately doubled risks for all-cause deaths (HR, 2.172; P=.01), cardiac deaths (HR, 2.253; P=.007), and MACE (HR, 1.962; P=.018).
  • Incretin therapy had no effect on all-cause or cardiac deaths, but MACE was significantly reduced (HR, 0.565; P=.003).

Limitations

  • Small sample size.
  • Short follow-up.