Li Zhiwei, Li Anying, Sun Dianhan, Shu Yusheng
Graduate School of Dalian Medical University, Dalian Medical University, 116044 Dalian, Liaoning, China.
Department of Thoracic Surgery, Subei People's Hospital of Jiangsu Province, 225001 Yangzhou, Jiangsu, China.
Rev Cardiovasc Med. 2024 May 6;25(5):154. doi: 10.31083/j.rcm2505154. eCollection 2024 May.
The present meta-analysis aimed to examine the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on the prognosis of diabetes patients who experienced acute myocardial infarction (AMI). This investigation encompassed an array of clinical endpoints, comprising cardiovascular death, myocardial reinfarction, all-cause mortality, major adverse cardiovascular events (MACEs), and rehospitalization.
The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Cochrane Library, Embase, and Web of Science databases were searched up to October 2023. Studies reporting clinical outcomes in diabetic patients who experienced AMI and were treated with SGLT2 inhibitors (SGLT2-I) were included. Two researchers independently selected the studies and assessed the risk of bias in the included studies using the Cochrane risk of bias tool for Risk for Bias In Non-randomized Studies-of Interventions (ROBINS-I).
A total of 2450 publications were initially retrieved; ultimately, five studies involving 5398 patients were included in the meta-analysis. The analysis revealed that SGLT2-I were associated with significantly lower risks of cardiovascular death (odds ratio (OR), 0.34; 95% CI, 0.14-0.82) and all-cause mortality (OR, 0.54; 95% CI, 0.38-0.76). However, SGLT2-I did not lead to a significant decrease in the rate of myocardial reinfarction (OR, 0.91; 95% CI, 0.65-1.29). SGLT2-I did lead to a significant reduction in MACEs (OR, 0.59; 95% CI, 0.35-1.0), but there was significant heterogeneity among the included studies. SGLT2-I also led to a significant reduction in rehospitalizations (OR, 0.45; 95% CI, 0.26-0.76). There was significant heterogeneity in the analysis of rehospitalization, but the effect remained significant when we excluded the main sources of heterogeneity (OR, 0.35; 95% CI, 0.24-0.52).
The pooled analyses revealed that SGLT2-I were associated with reductions in all-cause mortality, cardiovascular death, and rehospitalization. In the future, prospective studies with larger sample sizes are needed to confirm and refine these findings.
本荟萃分析旨在研究钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对发生急性心肌梗死（AMI）的糖尿病患者预后的影响。本调查涵盖了一系列临床终点，包括心血管死亡、心肌再梗死、全因死亡率、主要不良心血管事件（MACE）和再次住院。
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。检索了截至2023年10月的PubMed、Cochrane图书馆、Embase和科学网数据库。纳入报告了发生AMI并接受SGLT2抑制剂（SGLT2-I）治疗的糖尿病患者临床结局的研究。两名研究人员独立选择研究，并使用Cochrane偏倚风险工具（针对非随机干预研究的偏倚风险（ROBINS-I））评估纳入研究的偏倚风险。
最初检索到2450篇出版物；最终，五项涉及5398名患者的研究纳入了荟萃分析。分析显示，SGLT2-I与心血管死亡风险显著降低（优势比（OR），0.34；95%置信区间（CI），0.14-0.82）和全因死亡率显著降低（OR，0.54；95%CI，0.38-0.76）相关。然而，SGLT2-I并未导致心肌再梗死发生率显著降低（OR，0.91；95%CI，0.65-1.29）。SGLT2-I确实导致MACE显著降低（OR，0.59；95%CI，0.35-1.0），但纳入研究之间存在显著异质性。SGLT2-I还导致再次住院显著减少（OR，0.45；95%CI，0.26-0.76）。再次住院分析存在显著异质性，但当我们排除异质性的主要来源时，效应仍然显著（OR，0.35；95%CI，0.24-0.52）。
汇总分析显示，SGLT2-I与全因死亡率、心血管死亡和再次住院的降低相关。未来，需要更大样本量的前瞻性研究来证实和完善这些发现。
