SGLT2 Inhibitors and Improved Survival in Patients with Diabetes and Acute Myocardial Infarction: Evidence from an Electronic Health Record-Based Cohort Study.

BACKGROUND

Emerging evidence suggests that sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce cardiovascular events in patients with diabetes mellitus (DM) after acute myocardial infarction (AMI), but evidence in Asian populations remains limited.

OBJECTIVE

We assessed the impact of SGLT2 inhibitors on in-hospital, 30-day, and 30-day to 1-year mortality in a Northern Chinese real-world cohort.

METHODS

An electronic health record-based cohort was constructed from the Tianjin Health and Medical Data Platform from January 2013 to December 2022. Statistical analyses, including Kaplan-Meier survival analysis, multivariable regression analysis, and propensity score matching, were undertaken to evaluate the impact of SGLT2 inhibitors on in-hospital, 30-day, and 1-year mortality rates.

RESULTS

A total of 23,486 patients with both AMI and DM were included. Patients treated with SGLT2 inhibitors (n = 5053) were younger (64.2 vs 67.2 years) and had a higher frequency of dyslipidemia (26.4% vs 18.5%) and history of percutaneous coronary intervention (17.1% vs 15.3%) than those who did not receive them. After multivariable adjustment, the use of SGLT2 inhibitors showed a lower mortality rate during hospitalization (odds ratio 0.44; 95% confidence interval [CI] 0.33-0.58), at 30 days (hazard ratio 0.44; 95% CI 0.36-0.53), and at 30 days to 1 year (hazard ratio 0.86; 95% CI 0.73-1.00). These findings were further supported by propensity score matching and subgroup analyses, which consistently confirmed the reduction in mortality across all three time points.

CONCLUSION

In a real-world electronic health record-based cohort in China, this study confirmed a mortality benefit with the use of SGLT2 inhibitors in patients with combined DM and AMI. Further studies are needed to validate these benefits across broader populations.