基于倾向性评分匹配法研究SGLT2i对射血分数中间值心衰患者心血管结局的影响

doi:10.3969/j.issn.1006-6233.2022.10.018

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Abstract Objective: To observe the real-world effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in patients with chronic heart failure with mid-range ejection fraction (HFmrEF) with or without type 2 diabetes mellitus. Methods: This study is a single-center retrospective cohort study.A total of 728 HFmrEF patients with or without type 2 diabetes mellitus in Chengde Central Hospital from January 2019 to December 2021 were selected as research subjects and divided into exposure group and control group according to different treatment regimen.Patients in the control group were treated with guideline-oriented conventional heart failure medication,while patients in the exposure group were treated with dapagliflozin (at a dose of 10 mg once daily) in addition to conventional heart failure medication treatment.Both groups were treated with maintenance therapy for at least 6 months.SGLT2i was used as the grouping variable.Age,sex,smoking history,drinking history,hypertension history,diabetes history,hyperlipidemia history,coronary heart disease history,stroke history,percutaneous coronary intervention,History of PCI,history of coronary artery bypass grafting (CABG),history of permanent pacemaker implantation,and left ventricular ejection fraction (LVEF),estimated glomerular filtration rate (eGFR) and B-type natriuretic peptide (BNP) level were used as matching factors for propensity score.Propensity score matching was performed between the two groups.The Kaplan-Meier method was used to generate survival curves, and multivariate Cox proportional hazards regression was used to analyze end-point events.The primary endpoint event was a composite of hospitalization for heart failure,emergency admission for heart failure,and death from cardiovascular causes. Results: After propensity score matching,108 matching pairs were generated.The baseline characteristics of the two groups of patients were balanced,and there was no statistical difference.At a median follow-up of 19 months,the risk of the primary composite end point was significantly lower in the exposure group than in the control group(HR=0.51,95%CI:0.30~0.86,P=0.01).This effect was primarily associated with a lower risk of hospitalization for heart failure and emergency admission for heart failure in the exposed group.Compared with the control group,the risk of hospitalization for heart failure was significantly reduced in the exposure group (HR=0.53,95%CI:0.30~0.94,P=0.027).The risk of emergency admission for heart failure was significantly lower in the exposed group (HR=0.43,95%CI: 0.20~0.97, P=0.035).The risk of death from cardiovascular causes and death from any cause did not differ between the two groups. Conclusion: SGLT2i dapagliflozin significantly reduced the risk of hospitalization for heart failure and emergency admission for heart failure in patients with chronic HFmrEF with or without type 2 diabetes mellitus.

Key words： Heart failure Sodium-glucose cotransporter 2 inhibitors Cardiovascular outcomes HFmrEF Dapagliflozin

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.10.018 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I10/1672

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