Discussion
acute myocardial infarction, atheroprogression, inflammation, fibrosis, myocardial necrosis, atheroma, infarct, diabetes
ACUTE MYOCARDIAL INFARCTION, MYOCARDIAL INFARCTION, VASCULAR COMPLICATIONS, INFLAMMATION, VASCULAR INFLAMMATION, FIBROSIS, MYOCARDIAL NECROSIS, ATHEROMA, MYOCARDIAL DYSFUNCTION, AMI, ATHEROSCLEROTIC CARDIOVASCULAR DISEASE, INFARCT, DIABETES
EMMY was the first clinical trial showing beneficial effects of Empagliflozin after AMI on cardiac biomarkers as well as structural and functional cardiac parameters compared to placebo when being administered within 72 h after PCI. Data of the SGLT2-I AMI Protect registry suggested anti-inflammatory effects as mediator of beneficial clinical outcome [
Baseline characteristics in the entire EMMY cohort and analyzed sub-cohort
Systemic vascular inflammation plays a pivotal role in the progression and destabilization of atherosclerotic cardiovascular disease by inducing atheroprogression in a stable setting, initiating atheroma destabilisation provoking AMI as well as responding to myocardial necrosis with cardiac remodeling [SGLT2-inhibitors were found to exert beneficial effects on inflammatory biomarkers such as hsCRP and IL-6 compared to other glucose-lowering agents, and thus attenuating low-grade inflammation, a well-known key driver of vascular complications [The only available data regarding the effects of SGLT2-inhibitors on inflammatory biomarkers in acute myocardial infarction derive from the SGLT2-I AMI Protect international registry, which investigated the impact of chronic SGLT2-I treatment on inflammatory biomarkers in patients with diabetes presenting with AMI. This registry reports significantly lower baseline levels of leucocytes, neutrophils, and hsCRP in patients treated with SGLT2-I [In the acute phase of myocardial infarction, hsCRP is significantly higher compared to controls and positively correlated with the severity of coronary lesions and is an independent predictor for systolic and diastolic cardiac function [Similar results were found for interleukin-6 showing inverse correlations with systolic and diastolic function [The neutrophil-to-lymphocyte ratio (NLR) also demonstrated greater levels after initial presentation with AMI and was significantly positively related to troponin T levels, in line with data showing NLR to be associated with myocardial dysfunction [Leukocyte and neutrophil count were observed to be elevated in AMI showing positive correlations with peak Troponin T, infarct size as well as LVEF and therefore are independent predictors for cardiovascular outcome [The PLR as a suggested predictor for cardiovascular outcome [In the EMMY subgroup-analysis, the greater excursion of baseline inflammatory parameters was associated with larger infarct size as well as decreased cardiac function with a pronounced decline up to 26 weeks. The results demonstrate that inflammation is a physiological reaction leading to cardiac fibrosis to facilitate the healing process of damaged myocardium [