Empagliflozin_ACS_20_Slide_Large_Fonts.pptx

Use of Empagliflozin in ACS: Guideline Perspective

1. Use of Empagliflozin in ACS: Guideline Perspective A comprehensive review based on ADA, AHA/ACC, and ESC Guidelines Dr. Mohiminul Hossain

2. What is ACS? ACS includes STEMI, NSTEMI, and unstable angina Primary goal is reperfusion and stabilization High risk of HF and adverse remodeling post-AMI

3. Role of SGLT2 Inhibitors Originally approved for T2DM Now proven benefits in HFrEF and CKD regardless of diabetes Empagliflozin has unique myocardial effects

4. Overview of Empagliflozin SGLT2 inhibitor, once-daily oral agent Reduces glucose reabsorption in kidneys Promotes osmotic diuresis, natriuresis, weight loss

5. Cardiovascular Benefits Reduces CV death and HF hospitalization (EMPA-REG) Improves endothelial function and myocardial energetics Reduces inflammation and LV remodeling post-MI

6. EMMY Trial Highlights 476 AMI patients post-PCI randomized to empagliflozin vs placebo NT-proBNP significantly reduced after 26 weeks Improved LVEF and LV volumes

7. AMI Protect Registry Real-world study of T2DM patients with AMI Chronic SGLT2i use linked to reduced infarct size Lower glucose at presentation and better outcomes

8. ADA 2024 Guidelines Class I: Use SGLT2i in T2DM with ASCVD, HF, CKD Recommend BG <180 mg/dL during hospitalization No formal guidance on acute ACS use yet

9. AHA/ACC 2022 HF Guidelines Empagliflozin Class I for HFrEF, regardless of diabetes Start post-ACS if LVEF reduced No mention of use during acute MI

10. ESC ACS 2023 Guidelines No SGLT2i initiation during acute phase of MI ESC HF guidelines recommend empagliflozin in chronic HF May consider post-MI with LV dysfunction

11. Mechanisms in MI Recovery ↓ preload and afterload via diuresis ↓ myocardial fibrosis and inflammation (IL-6, CRP) Improves cardiac metabolism and ATP efficiency

12. Timing of Initiation EMMY trial: within 72h post-PCI in stable patients Avoid in hypotension, AKI, or active infection Safe in most post-MI with normal hemodynamics

13. Clinical Use Algorithm 1. Diagnose ACS and stabilize 2. Evaluate LV function 3. Consider SGLT2i post-MI in stable patients with T2DM or HFrEF

14. Who Should Get Empagliflozin? Patients with T2DM + recent ACS AMI patients with LVEF <50% Post-PCI patients with elevated NT-proBNP

15. Contraindications & Cautions Avoid in Type 1 DM, DKA, or severe renal failure (eGFR <20) Volume depletion, hypotension Monitor renal function and electrolytes

16. Future Research SOLOIST-ACS2: sotagliflozin post-MI outcomes EMMY Extension: long-term cardiac effects Watch for ESC 2025 or ADA 2026 updates

17. Real-World Evidence Registries show safe use in hospital settings Benefits seen in diverse populations Supports early adoption in select post-ACS patients

18. Summary of Recommendations ADA: SGLT2i for ASCVD, CKD, HF in T2DM AHA/ACC: For HFrEF, not acute MI ESC: Consider post-ACS if stable and with remodeling risk

19. Clinical Takeaways Empagliflozin improves cardiac outcomes after MI May initiate within 72h post-stabilization Need larger RCTs for guideline-level endorsement in ACS

20. Thank You / Questions Dr. Mohiminul Hossain Q&A and discussion