Cardiovascular disease (CVD) is the leading cause of death worldwide, and 85% of deaths are due to heart attack and stroke.1 Adults with diabetes have a 2- to 4-fold increased cardiovascular risk compared to adults without diabetes.2, 3, 4, 5 New cardiovascular risk factors have been identified to detect coronary heart disease, such as epicardial fat deposition.6 Epicardial fat is a metabolically active adipose tissue located between the myocardium and the visceral pericardium7 and a threshold volume of 113-120 cm3 has been shown to have the highest predictive value for future cardiovascular events.8,9 SGLT2i reduce cardiovascular outcomes in patients with previous cardiovascular events,10, 11, 12, 13, 14 but their efficacy is not well established in patients with ACS, early use could be a useful strategy to improve prognosis in these patients, one of the target organs on which they act is the epicardial adipose tissue, achieving a 10-20% change with 24 weeks of treatment in patients with diabetes but excluding ACS,15 therefore, the primary objective of this study was to evaluate the effect of dapagliflozin on EFV in patients with ACS assessed by non-contrast-enhanced cardiac tomography in addition to standard therapy, and a secondary objective was to analyze the association between EFV and the development of MACE, defined as heart failure, arrhythmia, unstable angina, and cardiovascular death.