Abstract
BACKGROUND: Early initiation of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, may improve cardiovascular outcomes in acute myocardial infarction (AMI) by mitigating adverse remodeling and enhancing cardiac function. OBJECTIVES: To assess dapagliflozin's impact on major adverse cardiovascular events (MACE) and left ventricular (LV) recovery in non-diabetic AMI patients using speckle-tracking echocardiography (STE). METHODS: This prospective, single-blinded randomized controlled trial (RCT) enrolled 200 non-diabetic patients with a first episode of AMI, including both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), following successful percutaneous coronary intervention (PCI). Participants received guideline-directed therapy and were randomized to dapagliflozin + standard care (Group I, n = 100) or standard care alone (Group II, n = 100). Echocardiographic parameters, including left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), LV end-diastolic volume (EDV), and LV end-systolic volume (ESV), were measured at baseline (1-3 days after acute myocardial infarction [AMI]) and at 6-month follow-up. Primary endpoint: 6-month MACE; secondary endpoints: cardiac function changes. RESULTS: MACE rates showed no significant difference (Group I: 4 % vs. Group II: 9 %; p = 0.152). Group I demonstrated superior cardiac improvement: higher LVEF (52.24 % vs. 47.66 %; p = 0.025), greater ESV reduction (-7.41 ± 13.20 mL vs. -2.52 ± 9.17 mL; p = 0.003), and improved GLS (-14.50 ± 3.27 % vs. -13.48 ± 3.77 %; p = 0.043). GLS change was significantly greater in Group I (Δ-1.467 ± 3.023 % vs. Δ-0.475 ± 2.252%; p = 0.009). Hypertensive and chronic kidney disease (CKD) subgroups showed enhanced myocardial recovery with dapagliflozin. CONCLUSION: Early dapagliflozin in non-diabetic AMI patients did not reduce 6-month MACE but significantly improved LV function and remodeling, suggesting cardioprotective benefits beyond glycemic control, especially in high-risk subgroups.