Effect of dapagliflozin on malignant ventricular arrhythmias in elderly after acute myocardial infarction a propensity score matched cohort study summary

This PACULit update summarizes a single-center, prospective observational study (ChangZhou Registry) evaluating whether initiating dapagliflozin during hospitalization for acute myocardial infarction reduces malignant ventricular arrhythmias in elderly patients and affects all-cause mortality over about seven months. In 2,607 patients aged 60 and older with confirmed AMI, those treated with dapagliflozin were compared to standard care using propensity score matching. The primary outcome was malignant ventricular arrhythmias during hospitalization; the secondary outcome was all-cause mortality (median ~211 days). Results showed malignant ventricular arrhythmias occurred in 2.2% of the dapagliflozin group versus 5.1% in controls, with odds ratios around 0.34 after matching (roughly 60–65% risk reduction). All-cause mortality was also significantly lower in the dapagliflozin group (p = 0.033). The discussion highlights potential mechanisms for antiarrhythmic effects, including improved myocardial metabolism, reduced fibrosis, ion-channel modulation, and attenuated sympathetic activity. Limitations include its single-center, observational design and potential residual confounding, limiting generalizability. The findings suggest potential benefits of early post-AMI dapagliflozin initiation in elderly patients at high arrhythmia risk and align with broader SGLT2 inhibitor cardiovascular effects, while underscoring the need for multicenter randomized trials focused on malignant ventricular arrhythmias.