Empagliflozin in Patients With Type 2 Diabetes Undergoing On-Pump CABG: The POST-CABGDM Randomized Clinical Trial.

Summary

In a pragmatic randomized trial of 145 T2DM patients undergoing on-pump CABG, perioperative empagliflozin reduced postoperative AKI (22.5% vs 39.1%; RR 0.57) without increasing adverse events. Atrial fibrillation and type 5 MI rates were similar, and all three deaths occurred in the control group.

Key Findings

• Postoperative AKI reduced with empagliflozin: 22.5% vs 39.1% (RR 0.57; 95% CI 0.34-0.96; P=0.03).
• No excess in postoperative atrial fibrillation (15.4% vs 13.5%) or type 5 MI (1.4% vs 4.1%).
• No significant differences in safety events; all three deaths occurred in the control arm.

Clinical Implications

Consider perioperative empagliflozin in T2DM patients scheduled for on-pump CABG to lower AKI risk, with attention to stopping 72 hours pre-op and monitoring standard safety parameters.

Limitations

• Single-center, open-label design with modest sample size (N=145).
• Short follow-up focused on AKI; longer-term renal and cardiovascular outcomes not assessed.

Future Directions

Multicenter, double-blind RCTs powered for renal and cardiovascular outcomes should validate perioperative SGLT2 strategies and define optimal timing and patient selection.