- Question
- Can dapagliflozin, added to usual care after acute myocardial infarction, improve cardiometabolic outcomes in patients without diabetes or chronic heart failure?
- Design
- International, registry-based, randomized, double-blind, placebo-controlled trial of 4017 patients. Because of low event accrual, a hierarchical win ratio analysis was adopted during the trial.
- Population
- Patients with acute myocardial infarction and impaired left ventricular systolic function, without prior diabetes or chronic heart failure.
- Intervention
- Dapagliflozin 10 mg once daily (2019 patients).
- Control
- Matching placebo (1998 patients).
- Primary outcome
- Hierarchical composite of death, hospitalization for heart failure, nonfatal MI, atrial fibrillation/flutter, type 2 diabetes, NYHA functional class at the last visit, and body weight decrease of 5% or greater at the last visit, analyzed by win ratio.
- Results
- Dapagliflozin produced significantly more wins than placebo on the primary composite (win ratio 1.34; 95% CI 1.20 to 1.50; P<0.001), driven mainly by the cardiometabolic components. Cardiovascular death or heart failure hospitalization occurred in 50/2019 (2.5%) with dapagliflozin and 52/1998 (2.6%) with placebo (HR 0.95; 95% CI 0.64 to 1.40).
- Safety
- No safety concerns were identified.
- Conclusion
- After about one year of treatment, dapagliflozin improved cardiometabolic outcomes but did not change the composite of cardiovascular death or heart failure hospitalization.
- Why it matters
- It provided evidence on SGLT2 inhibitor use after MI in patients without diabetes or heart failure, showing an overall cardiometabolic benefit without a demonstrated effect on hard clinical events, which were infrequent.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026