Long-term effect of empagliflozin and dapagliflozin in patients with heart failure undergoing coronary artery surgery/endovascular intervention: Is there a difference between these two SGLT2i on hospitalization, MACE, and mortality?
Authors: özgöl ilhan , Yiğit Gençer Ece , yıldız Cennet , Karabulut Dilay , Turhan Çağlar Fatma Nihan , Işıksungur Bıçakhan Burcu , Yücel Cihan , Yılmaz Melek , Ünal Orçun , Özsoy Sadiye Deniz , Yiğit Zerrin 
Published: February 2025

Title: Long-term effect of empagliflozin and dapagliflozin in patients with heart failure undergoing coronary artery surgery/endovascular intervention: Is there a difference between these two SGLT2i on hospitalization, MACE, and mortality? Objective: This study aims to compare the long-term effects of these two Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i) on hospitalization, major adverse cardiovascular events (MACE), and mortality in heart failure patients undergoing coronary artery bypass graft surgery (CABG)/percutaneous coronary intervention (PCI) on empagliflozin and dapagliflozin. Methods: 567 patients with heart failure undergoing CABG/PCI between 2014 and 2022 were studied, and 470 patients on empagliflozin and dapagliflozin were analyzed. The two groups of patients with preserved ejection fraction (HFpEF, n= 293) and patients with low/slightly reduced ejection fraction (HFdEF, n= 177) were analyzed in two subgroups: empagliflozin and dapagliflozin users. In addition to hospitalization, MACE and mortality, age, gender, disease history, and laboratory parameters were compared. Patients with (n=123) and without (n=347) cardiac MACE were also compared. Results: No significant difference was found between the groups in terms of age, HbA1c, creatinine levels, and other cardiovascular risk factors. Similar results were obtained in terms of overall mortality, cardiac mortality, MACE, cardiac MACE, and hospitalization.                                   In the HFpEF group comparing dapagliflozin with empagliflozin, overall mortality (17.1% vs. 19.9%, p=0.544), cardiac mortality (10.5% vs. 20%, p=0.341), MACE (29. 6% vs. 26.2%, p=0.522), cardiac MACE (28.3% vs 25.5%, p=0.595) and hospitalization (27% vs 22.7%, p=0.398). Similarly, in the HFrEF group, there was no difference in overall mortality (25.9% vs. 13.8%, p= 0.054), cardiac mortality (15.2% vs. 9.2%, p= 0.246), MACE (31.3% vs 20%, p= 0. 105), cardiac MACE (28.6% vs 18.5%, p= 0.134) and hospitalization (28.6% vs. 18.5%, p= 0.134) were similar between the two SGLT2i.                                     NT-proBNP (1451.38±2769.36 vs. 3052.30±3779.04, p< 0.001) and creatinine (0.98±0.38 vs. 1.12±0.87, p= 0.022) levels were significantly higher in the group with cardiac MACE. Conclusion: Empagliflozin and dapagliflozin did not show a significant difference in their long-term effects on hospitalization, MACE, and mortality in patients with heart failure undergoing coronary artery surgery/endovascular intervention. Larger and multicentre studies are required to confirm these findings. Keywords: Sodium-Glucose Co-Transporter 2 inhibitors, SGLT2i, empagliflozin, dapagliflozin, coronary artery surgery, heart failure, HFpEF, HFrEF, MACE