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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2025 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Aims: In the randomized DAPA-MI clinical trial, 10 mg of dapagliflozin once daily improved cardiometabolic outcomes versus placebo after acute myocardial infarction (MI) in patients without established diabetes or heart failure (HF). We assessed associations between baseline left ventricular ejection fraction (LVEF) and cardiometabolic outcomes in DAPA-MI. Methods: The primary outcome, assessed using the win ratio method, was the hierarchical composite of death, hospitalization for HF, non-fatal MI, atrial fibrillation/flutter, Type 2 diabetes, New York Heart Association classification at last visit and body weight decrease of ≥5% from baseline to last visit. For the present analysis, patients were categorized using LVEF at randomization (<50% or ≥50%). Results: Of the DAPA-MI participants with available LVEF data who received ≥1 dose of study drug (n = 3751), 2913 (77.7%) had LVEF <50% and 838 (22.3%) had LVEF ≥50%. The primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.38 (95% CI: 1.21, 1.57; P < 0.001) in patients with LVEF <50% and 1.32 (1.00, 1.73; P = 0.048) in patients with LVEF ≥ 50% (P interaction = 0.76). In a sensitivity analysis excluding patients with LVEF <30%, the primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.40 (95% CI: 1.22, 1.61; P < 0.001). There were no significant interactions between baseline LVEF and any secondary outcomes. Conclusions: Regardless of baseline LVEF, dapagliflozin resulted in significant cardiometabolic benefits versus placebo, although there was no impact on the composite of cardiovascular death or hospitalization for HF.
Author(s): Erlinge D, James S, Deanfield J, Eriksson N, de Belder M, Alchay M, Austin D, Jones DA, Ravn-Fischer A, Sederholm Lawesson S, Shah N, Strange JW, Szummer K, Ridderstrale W, Parvaresh Rizi E, Langkilde AM, Johansson PA, McGuire DK, Oldgren J, Storey RF
Publication type: Article
Publication status: Published
Journal: ESC Heart Failure
Year: 2025
Pages: Epub ahead of print
Online publication date: 16/09/2025
Acceptance date: 19/08/2025
Date deposited: 03/10/2025
ISSN (electronic): 2055-5822
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1002/ehf2.15420
DOI: 10.1002/ehf2.15420
Data Access Statement: Additional supporting information may be found online in the Supporting Information section at the end of the article.
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