Abstract 4139474: Safety of Sodium-Glucose Cotransporter-2 Inhibitors Peri-Percutaneous Coronary Intervention: A National Experience

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have cardio-renal protection benefits regardless of diabetes status. However, the outcomes of uninterrupted SGLT2i use peri-percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remain uncertain. Therefore, this study aimed to evaluate the safety of SGLT2i use peri-PCI. Methods: We conducted a retrospective observational cohort study that included all patients admitted with ACS who underwent revascularization with PCI at Qatar's main tertiary cardiology center between 1/01/2018 and 31/12/2020. The use of SGLT2i peri-PCI was defined as the established use of SGLT2i before the index admission or early initiation of SGLT2i during the index admission within 24 hours of contrast exposure. The study population was divided into two groups; (1) SGLT2i users; (2) SGLT2i non-users. The primary outcome was the risk of contrast-induced nephropathy (CIN) with SGLLT2i use, defined as an increase in serum creatinine by more than 0.3mg/dL or more than 50% of the baseline value within 48 hours of contrast exposure. A propensity score–matched model (1:1) was used to adjust for baseline characteristics between the study groups. Logistic regression analysis was used with a P-value <0.05, indicating statistical significance. Results: We included 3421 ACS patients who met the eligibility criteria (88% male, mean age 54±10 years, and 59% Asian), with 95 patients classified as SGLT2i users and 3326 as SGLT2i non-users. Using 1:1 propensity score matching, 95 patients were included per arm with an absolute standardized difference <0.1 for all baseline characteristics. The use SGLT2i peri-PCI was not associated with an increased risk of CIN [ before propensity score matching: 4 (4.2%) versus 146 (4.4%), aOR= 1.31 (0.45-3.78), P-value 0.622; after propensity score matching: 4 (4.2%) versus 5 (5.3%), OR= 0.79 (0.21-3.04), P-value 0.733]. Conclusion: Our findings suggest that the uninterrupted use of SGLT2i among patients with ACS undergoing PCI is safe without increasing the risk of CIN, warranting continuation of SGLT2i use or early initiation during ACS.