Semirani-Nezhad Davood, Soleimani Hamidreza, Taebi Morvarid, Roozbehi Khatere, Jahangiri Soodeh, Sattartabar Babak, Takaloo Fatemeh, Parastooei Bahar, Asfa Erfan, Salabat Danyal, Alishahi Mohammad Mobin, Mosayebi Fatemeh, Jenab Yaser, Gupta Rahul, Kuno Toshiki, Aronow Wilbert, Hosseini Kaveh
School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
BMC Cardiovasc Disord. 2025 Jul 19;25(1):527. doi: 10.1186/s12872-025-04992-2.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors increase survival rate in heart failure, but early initiation of these agents after acute myocardial infarction (MI) is controversial.
We searched PubMed, Scopus, Embase, and ClinicalTrial.gov for randomized clinical trials (RCTs) and propensity score matched (PSM) cohort studies up to September 29,2024. Eligible studies of patients with acute MI that were assigned to either SGLT2 inhibitors or placebo were enrolled in final meta-analysis. The primary endpoint was heart failure hospitalization (HHF). Secondary endpoints were: all-cause mortality, stroke, cardiovascular mortality, stroke and composite of major adverse cardiovascular events (MACE).We conducted frequentist and Bayesian meta-analyses.
we identified ten studies (7 RCTs and 3 PSMs) with 15,133 patients. Frequentist meta-analysis showed that SGLT2 inhibitors significantly reduced HHF [RR:0.67 (0.47-0.95); I2: 57%], and MACE significantly decreased in the SGLT2 inhibitor group [RR:0.77 (0.60-0.98); I2: 46%]. Bayesian meta-analysis for HHF suggested a non-significant reduction [RR: 0.8 (95% CrI: 0.4-1.4)]. No significant reduction was observed in SGLT2 inhibitors group regarding all-cause mortality, cardiovascular mortality, non-fatal MI and stroke.
Early initiation of SGLT2 inhibitors in acute MI was associated with reduced risk of HHF, though Bayesian analysis indicates uncertainty. MACE risk significantly reduced and no significant impact was observed on all-cause mortality, CV mortality, non-fatal MI and stroke.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可提高心力衰竭患者的生存率，但急性心肌梗死（MI）后早期启用这些药物存在争议。
我们检索了截至2024年9月29日的PubMed、Scopus、Embase和ClinicalTrial.gov上的随机临床试验（RCT）和倾向评分匹配（PSM）队列研究。符合条件的急性心肌梗死患者研究被分配到SGLT2抑制剂组或安慰剂组，纳入最终的荟萃分析。主要终点是心力衰竭住院（HHF）。次要终点包括：全因死亡率、中风率、心血管死亡率、中风率以及主要不良心血管事件（MACE）的综合发生率。我们进行了频率学派和贝叶斯荟萃分析。
我们确定了10项研究（7项RCT和3项PSM），共15133名患者。频率学派荟萃分析表明，SGLT2抑制剂显著降低了HHF[风险比（RR）：0.67（0.47 - 0.95）；I²：57%]，SGLT2抑制剂组的MACE也显著降低[RR：0.77（0.60 - 0.98）；I²：46%]。HHF的贝叶斯荟萃分析显示降低幅度不显著[RR：0.8（95%可信区间：0.4 - 1.4）]。在SGLT2抑制剂组中，全因死亡率、心血管死亡率、非致命性心肌梗死和中风率均未观察到显著降低。
急性心肌梗死后早期启用SGLT2抑制剂与降低HHF风险相关，尽管贝叶斯分析表明存在不确定性。MACE风险显著降低，且对全因死亡率、心血管死亡率、非致命性心肌梗死和中风未观察到显著影响。
