Coelho Meine Matheus, Santo Paula, Dolovitsch de Oliveira Fabiana, Lenci Marques Gustavo, Spadoni Barboza Joaquim
School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil.
Diagnostic Imaging and Specialized Diagnosis Unit, University Hospital of Federal University of São Carlos, 111, Luís Vaz de Camões Street - Vila Celina, São Carlos, SP, 13566-448, Brazil.
Heart Fail Rev. 2025 Jan;30(1):219-226. doi: 10.1007/s10741-024-10457-z. Epub 2024 Oct 29.
We aimed to assess the efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus placebo, initiated within the hospitalization period, in addition to habitual treatment, for treating adult patients with confirmed acute myocardial infarction (AMI). We also conducted subgroup analysis by diabetes mellitus (DM) status and type of AMI. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). The primary outcome was hospitalization for heart failure (HF). The secondary outcomes were all-cause death, cardiovascular death, and serious adverse events (AEs). We pooled risk ratios (RR) with a 95% confidence interval (CI) for binary outcomes. The between-study variance was assessed using tau statistics. We included five RCTs, encompassing 11,211 patients. SGLT2i significantly reduced the risk of hospitalization for HF compared to placebo (RR 0.73; 95% CI [0.61, 0.88]). However, the risk of all-cause death (RR 1.05; 95% CI [0.78, 1.41]) and cardiovascular death (RR 1.04; 95% CI [0.84, 1.29]) was similar between the groups, as well as the risk of serious AEs (RR 1.01; 95% CI [0.90, 1.14]). In the subgroup analysis by DM status and type of AMI, there were no significant subgroup differences for the outcomes of hospitalization for HF and all-cause death. In patients with AMI, treatment with SGLT2i is safe and significantly reduces the risk of hospitalization for HF, but it has no impact on all-cause death and cardiovascular death compared to placebo.
我们旨在评估在住院期间开始使用的钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）与安慰剂相比，在常规治疗基础上用于治疗确诊为急性心肌梗死（AMI）的成年患者的疗效和安全性。我们还按糖尿病（DM）状态和AMI类型进行了亚组分析。我们系统检索了PubMed、Embase和Cochrane图书馆以查找随机对照试验（RCT）。主要结局是因心力衰竭（HF）住院。次要结局是全因死亡、心血管死亡和严重不良事件（AE）。我们汇总了二分类结局的风险比（RR）及其95%置信区间（CI）。使用tau统计量评估研究间的异质性。我们纳入了5项RCT，共11,211例患者。与安慰剂相比，SGLT2i显著降低了HF住院风险（RR 0.73；95% CI [0.61, 0.88]）。然而，两组间全因死亡风险（RR 1.05；95% CI [0.78, 1.41]）、心血管死亡风险（RR 1.04；95% CI [0.84, 1.29]）以及严重AE风险（RR 1.01；95% CI [0.90, 1.14]）相似。在按DM状态和AMI类型进行的亚组分析中，HF住院和全因死亡结局在亚组间无显著差异。在AMI患者中，使用SGLT2i治疗是安全的，且显著降低了HF住院风险，但与安慰剂相比，对全因死亡和心血管死亡无影响。
