Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction: data from SGLT2-I AMI PROTECT Registry

Abstract Background Diabetes patients presenting with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) have an increased risk of contrast induced-acute kidney injury (CI-AKI). It has been shown that SGLT2-I have a nephroprotective effect. Purpose To analyze the association between SGLT2-I treatment and the development of contrast-induced acute kidney injury (CI-AKI) in diabetic patients with AMI (both ST- and non-ST segment elevation myocardial infarction - STEMI and NSTEMI) treated with PCI. Methods In this multicenter international registry, all consecutive diabetic AMI patients undergoing PCI between 2018 and 2021 were enrolled. Based on the admission anti-diabetic therapy, they were divided into SGLT-I users versus non-SGLT2-I users. All patients had estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2. No patient discontinued SGLT2-I during hospitalization. Serum creatinine was collected at admission and within 72 h post-PCI. CI-AKI was defined as absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine at 48-72 h after PCI compared to baseline serum creatinine values. Results The study population consisted of 646 AMI patients: 111 SGLT2-I users and 535 non-SGLT-I users. The mean age of the overall study population was 70 [61-79] years, and more than 77% were males. The mean T2DM duration was similar for both groups. SGLT2-I patients were younger and with better renal function at admission compared to non-SGLT2-I users (p<0.018 for both). Gender, cardiovascular risk factors, glucose-metabolic control, and comorbidities were similar in the two groups. The rate of STEMI and the main angiographic characteristics were similar between the two study groups, except for the higher number of stents implanted in the SGLT2-I group (p=0.041). Vascular access and contrast dosage did not differ between the 2 cohorts. A similar rate of complete revascularization, staged procedure and complex PCI was observed between the study groups. After PCI, the overall rate of CI-AKI was 76 (11.8%). SGLT2-I users exhibit a lower rate of CI-AKI compared to non-SGLT-I ones (5.4% vs 13.1%, p=0.02), with significantly lower creatinine values both after PCI (p=0.016) and at discharge (p=0.046). At multivariate analysis, after adjusting for all confounding factors, the use of SGLT2-I was identified as independent predictor of reduced rate of CI-AKI (OR 0.374; 95% CI 0.142-0.987, p=0.040). During a median follow-up of 24±13 months, patients with CI-AKI showed a higher incidence of MACE compared to patients without (44.7% vs 25.8%, p=0.001). Conclusion In diabetic patients with AMI, the use of SGLT2-I was associated with a lower risk of CI-AKI during index hospitalization, providing new insights into the cardioprotective effects of SGLT2-I in the setting of AMI.