Efficacy and Safety of Early Initiation of Sodium-Glucose Co-transporter-2 Inhibitors Following Acute Myocardial Infarction: A Systematic Review and Meta-analysis.

BACKGROUND

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are the preferred agents for managing type 2 diabetes in patients with established atherosclerotic cardiovascular disease and for reducing hospitalization for heart failure (HHF) in patients with heart failure with reduced and preserved ejection fraction. We undertook this meta-analysis, as, to date, no meta-analysis has holistically analysed the potential benefits and safety of SGLT2i in patients with acute myocardial infarction (MI).

METHODS

Electronic databases were searched for randomized controlled trials (RCTs) involving patients with MI who received SGLT2i in the intervention arm (initiated within 2 weeks of the index event) and placebo/active comparator in the control arm. The primary outcome was to evaluate the impact on cardiovascular death, all-cause death and HHF. The secondary outcomes were to evaluate the impact on echocardiographic parameters, N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, MI, stroke, all-cause hospitalization and safety issues.

RESULTS

From initially screened 8,922 articles, data from 6 RCTs were analysed (7,409 patients). Early initiation of SGLT2i following MI was associated with significantly lower future HHF (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.62-0.90; p=0.002; =0%) and significantly higher left-ventricular ejection fraction (mean difference [MD]: 1.65%; 95% CI: 0.34-2.96; p=0.01; =0%) compared with placebo. Compared with placebo, SGLT2i following MI had no beneficial impact on cardiovascular deaths (OR: 1.04; 95% CI: 0.83-1.30; p=0.76; =0%), all-cause mortality (OR: 1.00; 95% CI: 0.82-1.21; p=0.98; =0%), stroke (OR: 0.58; 95% CI: 0.26-1.27; p=0.17), all-cause hospitalization (OR: 1.13; 95% CI: 0.97-1.32; p=0.11; =0%) and percentage change in NT-proBNP (MD: 1.18%; 95% CI: -9.78 to 12.14; p=0.83; =52%). SGLT2i were well tolerated without increased ketoacidosis, acute renal failure or hepatic injury.

CONCLUSION

Early initiation of SGLT2i in acute MI is safe, well tolerated and associated with a reduction in HHF.