Cardiovascular and renal outcomes of sodium-glucose cotransporter-2 versus dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes post-PCI: a meta-analysis of 14,511 patients.

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI) are at high risk of adverse cardiovascular and renal outcomes. While both sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used in this population, direct evidence comparing their long-term efficacy and safety after PCI remains scarce. This meta-analysis aimed to compare cardiovascular and renal outcomes between SGLT-2i and DPP-4i in patients with T2DM post-PCI.

METHODS

PubMed, Web of Science, Scopus, and Cochrane CENTRAL were searched through June 2025. Primary outcomes were all-cause mortality, worsening renal function, and heart failure. We included primary studies and assessed the quality of studies using Newcastle Ottawa Scale. RevMan software was used to calculate hazard ratios (HR) estimates and 95% confidence intervals (CI) using the random-effects model.

RESULTS

We analyzed the outcomes between SGLT-2i (n = 7,025 patients) and DPP-4i (n = 7,459 patients). The mean age was 62.7 years, and 77.4% were males. SGLT-2i significantly reduced all-cause mortality (HR = 0.65; 95% CI: 0.54-0.79; P < 0.001) and the risk of worsening renal function (HR = 0.15; 95% CI: 0.09-0.26; P < 0.001). They also demonstrated a significant reduction in heart failure events (HR = 0.59; 95% CI: 0.48-0.74; P < 0.001). For myocardial infarction, a non-significant trend toward risk reduction with SGLT-2i was observed (HR = 0.85; 95% CI: 0.72-1.02; P = 0.08). For cerebrovascular accidents and the need for repeat revascularization (PCI/CABG), no significant difference was observed.

CONCLUSION

SGLT-2i demonstrates more clinical benefits, and current evidence supports its initiation over DPP-4i in T2DM patients after PCI.