Background: Empagliflozin and dapagliflozin are the most widely prescribed sodium–glucose cotransporter-2 inhibitors (SGLT2i) with established cardioprotective benefits across the spectrum of heart failure (HF). However, direct comparative data remain limited, particularly in patients with a history of coronary revascularization—a population at persistently high cardiovascular (CV) risk. This study aimed to compare the long-term cardiovascular outcomes of empagliflozin versus dapagliflozin in revascularized HF patients who had undergone coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: This retrospective cohort study included 631 HF patients who had undergone coronary revascularization (CABG or PCI) and were treated with an SGLT2 inhibitor (353 dapagliflozin, 278 empagliflozin) between 2014 and 2022 at a tertiary cardiovascular center. Patients were stratified by left ventricular ejection fraction (LVEF ≥ 50%: HFpEF; LVEF < 50%: HFrEF/HFmrEF). The primary outcomes were all-cause mortality, cardiac mortality, major adverse cardiovascular events (MACE), cardiac MACE, and HF-related hospitalization. Cox regression analyses—including time-dependent covariates—were performed to identify independent predictors of cardiac MACE. Results: Baseline demographic, clinical, and biochemical characteristics were comparable between groups. During a mean follow-up of 19.6 ± 1.5 months, there were no significant differences between dapagliflozin and empagliflozin in all-cause mortality (19.3% vs. 19.8%), cardiac mortality (11.0% vs. 12.2%), MACE (25.8% vs. 26.3%), cardiac MACE (23.8% vs. 21.9%), or hospitalization (23.8% vs. 23.7%) (all p > 0.05). Subgroup analyses by LVEF yielded consistent findings. In time-adjusted Cox modeling, age (HR = 2.089; 95% CI: 1.723–2.533; p < 0.001) and atrial fibrillation (AF) (log-rank p = 0.030) were identified as significant predictors of cardiac MACE, while creatinine and NT-proBNP lost significance after adjustment. Both age and AF showed time-varying hazard effects, with risk attenuation over time. Conclusions: In this real-world cohort of revascularized HF patients, empagliflozin and dapagliflozin demonstrated comparable long-term cardiovascular outcomes, supporting a class effect of SGLT2 inhibitors in this high-risk population. Beyond pharmacologic comparison, age and AF emerged as dynamic predictors of cardiac MACE, highlighting the importance of longitudinal, time-dependent risk assessment in heart failure management following coronary revascularization.

Objective: The objectives of this study were to characterise induction-phase regional cerebral oxygen saturation (rSO₂)–mean arterial pressure (MAP) dynamics during near-infrared spectroscopy (NIRS)-guided selective carotid endarterectomy (CEA) and to examine whether the Awake→Intubated pressure–oxygenation pattern may represent an early adjunctive physiological signal of subsequent cross-clamp-related ipsilateral cerebral desaturation. Methods: In this retrospective observational cohort study, 322 consecutive elective CEAs managed with an NIRS-guided selective shunting protocol between October 2019 and February 2025 were analysed, after excluding patients considered for routine pre-emptive shunting because of contralateral internal carotid artery occlusion or ≥70% stenosis. Standardised MAP and bilateral rSO₂ values were extracted at the Awake, Intubated, and Clamp stages, defined as 3 min after carotid cross-clamping. Awake→Intubated ipsilateral ΔrSO₂/ΔMAP was evaluated as a continuous, exploratory pressure–oxygenation index, with MAP–rSO₂ directional change classified as concordant or discordant. Clamp-related desaturation was defined as a ≥20% ipsilateral rSO₂ decrease from Awake to Clamp. Discrimination and adjusted associations were evaluated using receiver operating characteristic analysis and multivariable logistic regression, respectively. Results: Clamp-related ≥20% ipsilateral rSO₂ desaturation occurred in 43 patients (13.4%). The Awake→Intubated ipsilateral ΔrSO₂/ΔMAP ratio differed significantly between patients with and without ≥20% desaturation and showed significant discrimination on receiver operating characteristic analysis, with an area under the curve (AUC) of 0.799 (95% confidence interval [CI] 0.723–0.876; p < 0.001). Concordant pressure–oxygenation change was more frequent among patients with ≥20% desaturation (31/43, 72.1%), whereas discordant change predominated among those without desaturation (228/279, 81.7%; p < 0.001). In multivariable analysis, Awake→Intubated ipsilateral ΔrSO₂/ΔMAP remained associated with clamp-related ≥20% desaturation after adjustment (adjusted odds ratio [OR] 1.63, 95% CI 1.15–2.33; p = 0.006), along with symptomatic presentation and 50–69% contralateral stenosis. Postoperative stroke occurred in 4/322 patients (1.2%), and no 30-day mortality occurred. Conclusions: During NIRS-guided selective CEA, induction-phase rSO₂–MAP dynamics were associated with subsequent cross-clamp-related ipsilateral cerebral desaturation. As the outcome was a NIRS-defined desaturation rather than an independent clinical, neurological, or imaging endpoint, these findings indicate association with a surrogate marker rather than prediction of clinically relevant cerebral ischaemia. The Awake→Intubated ΔrSO₂/ΔMAP ratio and directional pressure–oxygenation pattern may represent early adjunctive physiological signals associated with clamp-related desaturation. These findings are hypothesis-generating and require prospective validation with systematic multimodal monitoring.