Efficacy of SGLT2i and GLP-1RA in Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION

The efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in acute myocardial infarction (AMI) remains uncertain. We aimed to investigate the effectiveness of SGLT2i and GLP-1RA in patients with AMI.

METHODS

We conducted a comprehensive search on PubMed, the Cochrane Library, Embase, and ClinicalTrials.gov databases to identify relevant randomized controlled trials (RCTs) up to January 2025. The primary outcomes included all-cause mortality and left ventricular ejection fraction (LVEF).

RESULTS

Six RCTs assessed SGLT2i (SGLT2i: n=5,660; placebo: n=5,651) and five assessed GLP-1RA (GLP-1RA: n=300; placebo: n=333). Compared with placebo, SGLT2i improved LVEF (mean difference = 1.58, p = 0.01, high certainty) and reduced heart failure hospitalization (HHF) (odds ratio = 0.78, p = 0.023, moderate certainty) in AMI patients. No significant benefit was observed in all-cause mortality with SGLT2i, and no significant benefits of GLP-1RA were observed in all-cause mortality, cardiac death, myocardial infarction relapse, infarct size, LVEF, left ventricular end-diastolic volume, or left ventricular end-systolic volume. TSA indicated potential false positives for the LVEF and HHF findings with SGLT2i.

DISCUSSION: Several limitations of the included studies include a small number of studies, heterogeneity in experimental design, and reliance on alternative endpoints.

CONCLUSION

SGLT2i improved LVEF and reduced HHF in patients with AMI but did not significantly improve all-cause mortality. GLP-1RA did not significantly improve LVEF or major clinical endpoints. Further large-scale RCTs are needed to verify these results and provide more robust evidence.