钠-葡萄糖协同转运蛋白2抑制剂对急性心肌梗死后临床结局的影响：一项随机对照试验的系统评价和荟萃分析

The effect of sodium-glucose co-transporter 2 inhibitors on clinical outcomes after acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials.

作者信息

Khan Ubaid, Amin Ahmed Mazen, Mohamed Taha Amira, Khlidj Yehya, M AlBarakat Majd, Elewidi Mariam, Abuelazm Mohamed, Turkmani Mustafa, Abdelazeem Basel, Laeeq Rida

机构信息

Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA.

Faculty of Medicine, Mansoura University, Mansoura, Egypt.

出版信息

Future Cardiol. 2025 Mar;21(3):177-190. doi: 10.1080/14796678.2025.2464449. Epub 2025 Feb 12.

INTRODUCTION

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular events, especially in diabetic patients. However, the cardioprotective effects of early SGLT2i administration following acute myocardial infarction (AMI) remain unclear.

OBJECTIVE

This study aims to investigate the impact of SGLT2is on clinical outcomes in patients post-AMI.

METHODS

A comprehensive search was conducted in PubMed, CENTRAL, WOS, Scopus, and EMBASE up to April 2024. Risk ratio (RR) was used for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI).

RESULTS

Seven studies with 11,407 patients were included. SGLT2is did not significantly reduce the incidence of major adverse cardiovascular events (MACE) (RR = 0.94, 95% CI [0.68, 1.29], = 0.69), all-cause mortality (RR = 1.01, 95% CI [0.84, 1.21], = 0.93), or stroke (RR = 0.61, 95% CI [0.29,1.28], = 0.19). However, SGLT2is significantly reduced the risk of heart failure (RR = 0.76, 95% CI [0.63, 0.91], < 0.01) and improved left ventricular ejection fraction (MD = 1.86, 95% CI [1.58, 2.14], < 0.01).

CONCLUSION

In post-AMI patients, SGLT2is do not significantly affect MACE or mortality but are associated with reduced heart failure risk and improved ejection fraction.

PROTOCOL REGISTRATION

PROSPERO identifier number: CRD42024506806.

引言

钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）可降低心血管事件风险，尤其是在糖尿病患者中。然而，急性心肌梗死（AMI）后早期使用SGLT2i的心脏保护作用仍不明确。

目的

本研究旨在探讨SGLT2i对AMI后患者临床结局的影响。

方法

截至2024年4月，在PubMed、CENTRAL、WOS、Scopus和EMBASE中进行了全面检索。二分类结局采用风险比（RR），连续型结局采用均值差（MD），并给出95%置信区间（CI）。

结果

纳入了7项研究，共11407例患者。SGLT2i并未显著降低主要不良心血管事件（MACE）的发生率（RR = 0.94，95%CI[0.68，1.29]，P = 0.69）、全因死亡率（RR = 1.01，95%CI[0.84，1.21]，P = 0.93）或卒中发生率（RR = 0.61，95%CI[0.29，1.28]，P = 0.19）。然而，SGLT2i显著降低了心力衰竭风险（RR = 0.76，95%CI[0.63，0.91]，P < 0.01），并改善了左心室射血分数（MD = 1.86，95%CI[1.58，2.14]，P < 0.01）。