Administration of Sodium-Glucose Cotransporter-2 Inhibitors Following Acute Myocardial Infarction: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Trials.

OBJECTIVE

Individuals with acute myocardial infarction (AMI) face a considerable mortality risk. Recent evidence suggests that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) may provide cardioprotective benefits, particularly in cases of heart failure (HF). However, the evidence regarding SGLT-2i use in AMI patients remains contradictory and ambiguous. This study investigates the efficacy and safety of SGLT-2i administration following AMI.

METHODS

We systematically searched Scopus, Cochrane Library, MEDLINE, and ClinicalTrials.gov for potential articles using specific keywords, with the search extending until December 15th, 2024. All published randomized controlled trials (RCTs) assessing SGLT-2i use following AMI were included. Outcomes were expressed as risk ratios (RRs) and standardized mean differences.

RESULTS

A total of 7 RCTs were included. Our pooled analysis demonstrated that SGLT-2i administration post-AMI was associated with a reduced risk of HF hospitalization (RR, 0.72; 95% confidence interval [CI], 0.60, 0.86; p=0.0004, I2=0%) and an improved left ventricular ejection fraction (LVEF) (SMD, 0.29; 95% CI, 0.03, 0.55; p=0.03; I2=60%) compared with placebo. However, there were no significant differences in all-cause mortality (p=0.94), cardiovascular (CV)-related mortality (p=0.77), stroke/transient ischemic attack (p=0.17), or major adverse CV events (p=0.16). The incidences of serious adverse events, diabetic ketoacidosis, and urinary tract infections were comparable between the 2 groups.

CONCLUSION

The administration of SGLT-2i following AMI may reduce the risk of HF hospitalization and improve LVEF, without affecting mortality outcomes. Overall, SGLT-2i proved to be a comparatively safe treatment option.

TRIAL REGISTRATION: PROSPERO Identifier: CRD42024627125.