Early use of sodium -glucose cotransporter 2 inhibitors after acute myocardial infarction: a systematic review and meta -analysis of randomized controlled trials

Abstract

INTRODUCTION Acute myocardial infarction (AMI) continues to be a primary cause of posthospitalization heart failure (HF), severely impacting morbidity, health care resource consumption, and mortality rates. OBJECTIVES This meta -analysis sought to assess the efficacy and safety of the early introduction of sodium -glucose cotransporter 2 inhibitors (SGLT2is) in patients hospitalized for AMI, irrespective of previous HF or diabetes history. PATIENTS AND METHODS A comprehensive search was carried out, up until June 10, 2025, in 6 major databases, including randomized controlled trials (RCTs) assessing SGLT2is that were started within 14 days of hospitalization for AMI. RESULTS Seven RCTs were included (n = 11 405) comparing SGLT2is with placebo or standard medical therapy without SGLT2is, with follow -up ranging from 6 to 18 months. The commencement of SGLT2i therapy markedly diminished the odds of HF hospitalization (odds ratio [OR], 0.71; 95% CI, 0.58–0.86; P = 0.004). No notable changes were detected in all -cause mortality (OR, 1.05; 95% CI, 0.77–1.43), cardiovascular mortality (OR, 1.04; 95% CI, 0.83–1.3), major adverse cardiovascular events (OR, 0.94; 95% CI, 0.85–1.05), recurrent MI (OR, 1.12; 95% CI, 0.73–1.72), or stroke (OR, 0.58; 95% CI, 0.26–1.27). CONCLUSIONS Early initiation of SGLT2is post -AMI significantly reduces the risk of subsequent HF hospitalization without increasing the risk of adverse events. However, no mortality benefit was observed. These findings support the selective use of SGLT2is in post -AMI patients at a high risk for HF, while high-lighting the need for further large -scale trials to assess long -term outcomes and refine patient selection.