Возможности оптимизации медикаментозной терапии при инфаркте миокарда: согласованное мнение по применению ингибиторов натрий-глюкозного ко-транспортера 2‑го типа. Согласительный документ группы экспертов

Ишемическая болезнь сердца, в том числе перенесенный инфаркт миокарда (ИМ), - одна из основных причин развития и прогрессирования сердечной недостаточности (СН). Наличие у пациента СН до ИМ или ее развитие на фоне острой коронарной катастрофы является крайне неблагоприятным прогностическим фактором, приводящим к кратному повышению риска смерти и повторных госпитализаций по причине СН в постинфарктном периоде. В 2024 г. опубликованы результаты двух рандомизированных клинических исследований - РКИ (DAPA-MI и EMPACT-MI) по оценке влияния ингибиторов натрий-глюкозного ко-транспортера 2‑го типа (иНГЛТ2) на клинические исходы у пациентов с острым ИМ. В обоих исследованиях предустановленная первичная комбинированная конечная точка не была достигнута. При этом показано, что прием иНГЛТ2 достоверно снижал риск госпитализаций по причине СН (эмпаглифлозин) и способствовал улучшению метаболических исходов (дапаглифлозин). Кроме того, продемонстрирована безопасность раннего начала применения иНГЛТ2 в острый период ИМ. На основании анализа результатов имеющихся рандомизированных и наблюдательных клинических исследований рабочей группой обоснована необходимость внедрения результатов проведенных РКИ в клиническую практику и предложен алгоритм назначения иНГЛТ2 пациентам с острым ИМ. Таким образом, при наличии убедительных анамнестических критериев диагноза или ранее установленных сахарного диабета 2‑го типа и / или хронической болезни почек и / или СН продолжение или своевременное начало применения иНГЛТ2 во время госпитализации по поводу индексного ИМ рекомендованы для улучшения сердечно-сосудистых и почечных исходов. На основании результатов РКИ у пациентов с острым ИМ с учетом индивидуальных факторов риска развития СН можно рассмотреть начало применения иНГЛТ2 перед выпиской с целью снижения риска госпитализации по причине СН.

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