Lin Norman H Y, Ho Jamie S Y, Leow Aloysius S T, Teo Yao Hao, Yeo Brian S Y, Zhang Audrey A Y, Goh Fang Qin, Yeo Tiong-Cheng, Wong Raymond C C, Chai Ping, Chan Mark Y Y, Sia Ching-Hui
Department of Medicine, National University Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Am J Cardiovasc Drugs. 2025 Jan;25(1):71-81. doi: 10.1007/s40256-024-00680-2. Epub 2024 Oct 14.
Cardiovascular disease is on the rise globally, with ischemic heart disease being the leading cause of mortality and morbidity. While sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve cardiovascular outcomes in patients with heart failure, evidence is limited in guiding initiation in post-acute myocardial infarction (post-AMI) patients. Hence, this study aimed to appraise the current literature on the effect of SGLT2i on the clinical outcomes of post-AMI patients.
A comprehensive search of PubMed, EMBASE, SCOPUS, and ClinicalTrials.gov was conducted up to 1 May 2024. Only randomized controlled trials studying the use of SGLT2i in post-AMI patients were included. We included adult patients aged 18 years old and older diagnosed with AMI and initiated on SGLT2i in the acute post-AMI setting. SGLT2i studies solely in heart failure settings were excluded.
Eight clinical trials were included in the systematic review, comprising 11,436 patients. Compared with placebo, SGLT2i initiation in post-AMI patients significantly reduced total number of heart failure hospitalizations (risk ratio [RR] 0.74, 95% confidence interval [CI] 0.62-0.90) and was associated with a lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (- 26.67 pg/ml, 95% CI - 41.74 to - 11.59). There was no difference in all-cause mortality (RR 1.02, 95% CI 0.81-1.28), cardiovascular mortality (RR 1.03, 95% CI 0.83-1.28), change in left ventricular ejection fraction, and glycated hemoglobin (HbA1c), as compared with placebo.
SGLT2i use in patients with AMI was associated with a reduction in heart failure hospitalizations and a decrease in NT-proBNP. There were no significant differences in mortality outcomes.
PROSPERO identifier number CRD42024540843.
心血管疾病在全球范围内呈上升趋势，缺血性心脏病是导致死亡和发病的主要原因。虽然钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）已被证明可改善心力衰竭患者的心血管结局，但在指导急性心肌梗死后（post-AMI）患者开始使用方面的证据有限。因此，本研究旨在评估当前关于SGLT2i对急性心肌梗死后患者临床结局影响的文献。
截至2024年5月1日，对PubMed、EMBASE、SCOPUS和ClinicalTrials.gov进行了全面检索。仅纳入研究SGLT2i在急性心肌梗死后患者中使用的随机对照试验。我们纳入了年龄在18岁及以上、诊断为急性心肌梗死且在急性心肌梗死后开始使用SGLT2i的成年患者。仅在心力衰竭环境中进行的SGLT2i研究被排除。
系统评价纳入了8项临床试验，共11436例患者。与安慰剂相比，急性心肌梗死后患者开始使用SGLT2i显著降低了心力衰竭住院总数（风险比[RR]0.74，95%置信区间[CI]0.62-0.90），并与较低的N末端B型利钠肽原（NT-proBNP）水平相关（-26.67 pg/ml，95%CI -41.74至-11.59）。与安慰剂相比，全因死亡率（RR 1.02，95%CI 0.81-1.28）、心血管死亡率（RR 1.03，95%CI 0.83-1.28）、左心室射血分数变化和糖化血红蛋白（HbA1c）无差异。
急性心肌梗死患者使用SGLT2i与心力衰竭住院率降低和NT-proBNP降低相关。死亡率结局无显著差异。
PROSPERO标识符编号CRD42024540843。
