Do sodium-glucose cotransporter-2 inhibitors provide protection against contrast-induced nephropathy in patients with acute coronary syndrome?

Aims Contrast-induced nephropathy (CIN) remains a significant complication following coronary angiography (CAG) and percutaneous coronary intervention (PCI), particularly among patients with diabetes mellitus. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective effects in chronic kidney disease; however, their role in preventing CIN remains unclear. Methods In this retrospective, single-center study, 206 patients with diabetes mellitus and acute coronary syndrome (ACS) undergoing CAG or PCI were included. Patients were divided into two groups based on SGLT-2i usage. Lasso penalized regression analysis was performed to identify significant predictors of CIN, followed by multivariate logistic regression analysis to adjust for potential confounders. The predictive performance of the model was assessed using a receiver-operating characteristic curve. Results The study included 94 SGLT-2i users and 112 nonusers. CIN occurred less frequently among SGLT-2i users (9.6 vs. 16.1%). Lasso regression identified female sex, SGLT-2i usage, contrast amount, baseline glomerular filtration rate (GFR), and left ventricular ejection fraction (LVEF) as significant predictors of CIN. Multivariate analysis demonstrated that SGLT-2i usage was independently associated with a reduced risk of CIN (odds ratio: 0.24, P = 0.012), while female sex, lower LVEF, worse baseline GFR, and higher contrast volume were associated with increased CIN risk. The final model exhibited excellent discriminative ability (area under the curve: 0.85). Conclusion SGLT-2i usage was independently associated with a decreased risk of CIN among diabetic patients with ACS undergoing coronary interventional procedures. Female sex, reduced LVEF, impaired renal function, and greater contrast volume emerged as independent predictors of increased CIN risk.