DAPAgliflozine to Attenuate Cardiac RemOdeling afTEr aCuTe myOcardial Infarction

Inclusion Criteria:

- Age ≥18 years;

- STEMI (e.g., ST elevation above the J-point of ≥0.1 millivolt in ≥two contiguous leads
or left bundle branch block) or very high-risk NSTEMI (e.g., dynamic ECG changes or
ongoing chest pain or acute heart failure or hemodynamic instability independent of
ECG changes or life-threatening ventricular arrhythmias) with LV dysfunction (LVEF
≤45%); after completion of PCI or angiography procedure

- eGFR ≥30 mL/Min per 1.73m²;

- Systolic blood pressure (SBP) before first dosing >110 mmHg;

- Diastolic blood pressure (DBP) before first dosing >70 mmHg;

- Ability to provide written informed consent and willing to participate in the 6-month
follow-up period.

- Affiliation to a national health care system (AME are not allowed).

Exclusion Criteria:

Exclusion Criteria :

- Cardiogenic shock (SBP <90 mmHg with clinical signs of low output or patients
requiring inotropic agents) at randomization;

- Referred to surgery for coronary artery bypass grafting (CABG) or treatment of acute
complications (e.g. ventricular septal rupture);

- Any other form of diabetes than diabetes type 2

- History of diabetic ketoacidosis (DKA);

- Blood pH <7.32;

- ; Known contra-indication to SGLT-2 inhibitors (hereditary problems of galactose
intolerance, total lactase deficiency or glucose-galactose malabsorption);

- >1 episode of severe hypoglycemia within the last 6 months under treatment with
insulin or sulfonylurea;

- Acute symptomatic urinary tract infection (UTI) or genital infection at the time of
randomization;

- Concomitant treatment (and/or within the 4 weeks prior to the baseline visit) with any
SGLT-2 inhibitor (dapagliflozin, canagliflozin, empagliflozin)

- Echocardiographic examination of insufficient quality to permit adequate analysis of
the study end-points.

- Impossibility to evaluate cardiac remodeling using TTE (e.g., pacemaker or
defibrillator …);

- Atrial fibrillation rhythm at randomization;

- Life expectancy <6 month;

- Known pregnancy at time of randomization;

- Breastfeeding women

- Females of childbearing potential without adequate contraceptive methods (i.e.
sterilization, intrauterine device, vasectomized partner; or medical history of
hysterectomy)

- Current participation in another interventional trial. Patients under guardianship or
curatorship