Abstract 4141342: Impact of sodium-glucose cotransporter-2 inhibitor on postoperative atrial fibrillation and myocardial injury after coronary artery bypass grafting in patients with diabetes

Background: Recent studies showed that sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduce the risk of atrial fibrillation (AF) and the recurrence of AF after catheter ablation in diabetic patients. However, there is no evidence of a relationship between SGLT2i use and the incidence of postoperative atrial fibrillation (POAF), a common complication after coronary artery bypass grafting (CABG). Additionally, the protective mechanisms of SGLT2i on cardiomyocytes suggest a possible association with reduced postoperative myocardial injury. Methods: SGLT2i use was defined as taking SGLT2i at the time of admission and discontinuing it at least 3 days before surgery. Adult diabetic patients without a history of AF undergoing primary CABG (±valve surgery) between October 2023 and December 2024 were included from a large prospective cohort. Patients with acute coronary syndromes or emergency surgery were excluded. Patients in the SGLT2i group were matched by propensity score with the control group (no SGLT2i use) at a 1:3 ratio. Generalized estimating equations were utilized for repeated measures data. Primary outcomes were the incidence of POAF and the level of high-sensitivity troponin I (hs-cTnI) within 5 days post-surgery. Secondary outcomes included in-hospital death, stroke, perioperative myocardial infarction (MI), acute kidney injury stage 2/3, reoperation, ICU stay duration, postoperative NT-proBNP levels, and blood inflammatory biomarkers. Diabetic ketoacidosis (DKA) was also monitored. Results: The cohort included 10,106 subjects, with 1,407 (13.9%) in the SGLT2i group. A total of 1,001 patients in the SGLT2i group and 3,003 in the control group were analyzed, with well-matched baseline characteristics after propensity scoring. No DKA events were found in either group. After adjusting for multiple confounding factors, the incidence of POAF was significantly lower in the SGLT2i group (19.6% vs. 25.7%, odds ratio: 0.686, 95% confidence interval: 0.592 - 0.794, P < 0.001). In the SGLT2i group, hs-cTnI levels within 5 days postoperatively decreased by an average of 0.36 ng/ml (95% CI: -0.707 to -0.012, P = 0.013). No significant differences were observed in postoperative NT-proBNP, inflammatory biomarkers, or ICU stay. No differences in other perioperative clinical outcomes were observed. Conclusion: SGLT2 inhibitors can reduce the incidence of POAF and levels of hs-cTnI following CABG, without an increased risk of other perioperative adverse events