Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.