Association between dapagliflozin use and coronary collateral circulation in patients with type 2 diabetes: A hypothesis-generating study

Abstract

Coronary collateral circulation (CCC) plays a vital compensatory role in patients with type 2 diabetes mellitus (T2DM) and obstructive coronary artery disease (CAD). However, impaired collateral development is common in T2DM, and therapeutic strategies to enhance CCC are underexplored. We aimed to evaluate the association between sodium-glucose cotransporter-2 inhibitor dapagliflozin use and coronary collateral development in T2DM patients with obstructive CAD. This cross-sectional study evaluated 59 T2DM patients undergoing coronary angiography for total coronary occlusion. CCC was graded using the Rentrop classification, and patients were divided into poor and good CCC groups. Propensity score matching (PSM) and multivariate logistic regression analyses were performed to identify independent predictors of good CCC. Good CCC was observed in 74.6% of patients. Dapagliflozin use was significantly more common among patients with good CCC (81.8% vs 13.3%, p < 0.001). In multivariate analysis, dapagliflozin use was significantly associated with good CCC (odds ratio: 32.5; 95% confidence interval (CI): 5.21–642, p = 0.002). After PSM, the dapagliflozin use remained a significant predictor. ROC analysis demonstrated strong discriminative ability (AUC: 0.821; 95% CI: 0.711–0.932). Dapagliflozin use is likely associated with enhanced coronary collateral development in T2DM patients with obstructive CAD, indicating a possible mechanism underlying its cardioprotective effects beyond glycemic control.