Effect of Empagliflozin on No-Reflow in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract Aim and Objectives To Assess the effect of Empagliflozin preloading in non-diabetic STEMI patients before PPCI on procedural, in-hospital outcomes and short-term MACE in a single tertiary center. Patients and Methods The study was carried out on 200 non-diabetic STEMI patients presenting to Ain Shams university hospitals within the first 8 hours of symptom onset. Patients were randomised into 2 groups, the intervention group received 10mg Empagliflozin before primary percutaneous coronary intervention (PPCI)with the standard medical therapy while the control group received only the standard medical therapy. Patients were assessed for demographic data, risk factors, procedural outcomes, clinical and in-hospital outcomes, and short-term MACE up to 1 month. Results Our study found a significant difference between the intervention and control groups regarding contrast volume with a mean of 131 ml in intervention group and 144 ml in control group with a p value of 0.009, incidence of no-reflow with 34.5% in the control group and only 18.2% in the intervention group and a p value of 0.014, myocardial blush grade were 84.1% of the patients in intervention group showed MBG III while only 65.5% of the patients in the control group showed the same results with a p value of 0.019, St-segment resolution post PCI as 59.1% had complete ST segment resolution and only 39.1% in the control group with a p-value of 0.027, and total Major Adverse Cardiovascular events (MACE) in the first month affecting 44.8% of the patients in the control group and only 28.4% in the intervention group with a p- value of 0.024. Conclusion Our study showed that pre-loading of STEMI patients with Empagliflozin resulted in improvement in procedural outcomes, decreasing the incidence of coronary no-reflow, improvement in patient’s course during hospital stay and short-term MACE. Improvement in MACE was mainly due to reduced HF hospitalisations and anginal symptoms.