Cardiovascular Outcomes of Perioperative Sodium-Glucose Transporter 2 Inhibition in Cardiac Surgery Patients: An Open-Label Randomized Pilot Study
Abstract
Background: Previous studies have shown cardiovascular benefits of SGLT2 inhibitors. The aim of this study was to evaluate the cardiovascular effects of perioperative SGLT2 inhibition in patients undergoing cardiac surgery.
Methods: In this open-label pilot study, adult patients undergoing cardiac surgery were randomized to receive a daily dose of empagliflozin (10 mg; oral) 3 days before surgery until 2 days after surgery, or standard of care. Blood pressure, heart rate, postoperative diuresis, intravenous fluid administration, fluid balance, and vasoactive support were compared between groups during the first 24 postoperative hours.
Results: About 55 patients (sex: 73% male, age: 66 ± 10 years, BMI: 28 ± 4 kg/m2, empagliflozin n = 25, control n = 30) were included in this study and analyzed according to the intention-to-treat principle. Empagliflozin was associated with increased diuresis, mean difference 549 mL (95% CI 258-839, p < 0.001), and less positive fluid balance postoperatively, mean difference -1217 mL (95% CI -2373- -61, p = 0.039). Empagliflozin did not increase the amount of intravenous fluid administered. In the empagliflozin group, norepinephrine was infused for 11.8 ± 11.5 h compared to 19.3 ± 19.3 h in the control group (p = 0.080). No significant between-group differences were observed in postoperative blood pressure and heart rate.
Conclusions: Perioperative SGLT2 inhibition was associated with increased diuresis and lesser fluid accumulation without an…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 55 participants or records.
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