Dutta Deep, Nagendra Lakshmi, Kamrul-Hasan Abm, Mahajan Kunal
Department of Endocrinology, CEDAR Super-speciality Healthcare, Dwarka, New Delhi, India.
Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, India.
touchREV Endocrinol. 2025 May;21(1):14-23. doi: 10.17925/EE.2025.21.1.1. Epub 2025 Feb 7.
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).
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.
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.
Early initiation of SGLT2i in acute MI is safe, well tolerated and associated with a reduction in HHF.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是治疗已确诊动脉粥样硬化性心血管疾病的2型糖尿病患者以及降低射血分数降低和保留的心力衰竭患者心力衰竭住院率（HHF）的首选药物。我们进行了这项荟萃分析，因为迄今为止，尚无荟萃分析全面分析SGLT2i在急性心肌梗死（MI）患者中的潜在益处和安全性。
检索电子数据库，查找涉及MI患者的随机对照试验（RCT），干预组接受SGLT2i（在索引事件后2周内开始使用），对照组接受安慰剂/活性对照药。主要结局是评估对心血管死亡、全因死亡和HHF的影响。次要结局是评估对超声心动图参数、N末端B型利钠肽原（NT-proBNP）、高敏C反应蛋白、MI、中风、全因住院和安全性问题的影响。
从最初筛选的8922篇文章中，分析了6项RCT的数据（7409例患者）。与安慰剂相比，MI后早期开始使用SGLT2i与未来HHF显著降低（比值比[OR]：0.75；95%置信区间[CI]：0.62-0.90；p=0.002；I²=0%）以及左心室射血分数显著升高（平均差值[MD]：1.65%；95%CI：0.34-2.96；p=0.01；I²=0%）相关。与安慰剂相比，MI后使用SGLT2i对心血管死亡（OR：1.04；95%CI：0.83-1.30；p=0.76；I²=0%）、全因死亡率（OR：1.00；95%CI：0.82-1.21；p=0.98；I²=0%）、中风（OR：0.58；95%CI：0.26-1.27；p=0.17）、全因住院（OR：1.13；95%CI：0.97-1.32；p=0.11；I²=0%）和NT-proBNP的百分比变化（MD：1.18%；95%CI：-9.78至12.14；p=0.83；I²=52%）没有有益影响。SGLT2i耐受性良好，未增加酮症酸中毒、急性肾衰竭或肝损伤的发生率。
急性MI患者早期开始使用SGLT2i是安全的，耐受性良好，并与HHF降低相关。
