Dapagliflozin Effects on Cardiometabolic Outcomes in Patients With an Acute Heart Attack.

Inclusion Criteria:

• Participant must be ≥18 at the time of signing the informed consent

• Confirmed MI, either STEMI or NSTEMI, according to the fourth universal definitionof MI (Thygesen et al 2019), within the preceding 7 days, or 10 days if earlierrandomisation is not feasible

• Evidence of impaired regional or global LV systolic function at any timepoint duringcurrent MI-related hospitalisation (established with echocardiogram, radionuclideventriculogram, contrast angiography or cardiac MRI) or definitive evidence on ECGof Q wave MI (defined as presence of Q waves in two or more contiguous leads,excluding leads III and aVR, and meeting all the following criteria: at least 1.5 mmin depth; at least 30 ms in duration; and, if R wave present, more than 25% of thesize of the subsequent R wave)

• Hemodynamically stable at randomization (no episodes of symptomatic hypotension, orarrhythmia with haemodynamic compromise in the last 24 hours).

• Male or female

• Capable of giving signed informed consent which includes compliance with therequirements and restrictions listed in the informed consent form (ICF) and in theprotocol

• Provision of signed and dated, written informed consent prior to any mandatory studyspecific procedures, sampling, and analyses

Exclusion Criteria:

• Known type 1 diabetes mellitus (T1DM) or T2DM at the time for admission. Patientswith hyperglycaemia, but without a diagnosis of diabetes mellitus prior to the indexevent, are eligible at the discretion of the Investigator. Patients who present withsigns and symptoms consistent with ketoacidosis, including nausea, vomiting,abdominal pain, malaise and shortness of breath should be assessed for ketoacidosis,and if ketoacidosis is confirmed the patient should not be randomized.

• Chronic symptomatic HF with a prior HHF within the last year and known reducedejection fraction (LVEF≤40 %), documented before the current MI hospitalization

• Severe (eGFR <20 mL/min/1.73 m2 by local laboratory), unstable or rapidlyprogressing renal disease at the time of randomization

• Severe hepatic impairment (Child-Pugh class C) at the time of inclusion into thetrial

• Active malignancy requiring treatment at the time of screening, except for basalcell- or squamous cell carcinoma of the skin, presumed possible to treatsuccessfully

• Any non-CV condition, eg malignancy, with a life expectancy of less than two yearsbased on the investigator´s clinical judgement

• Currently on treatment, or with an indication for treatment, with a sodium glucoseco-transporter 2 inhibitor (SGLT2-inhibitor)