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Sodium-Glucose Cotransporter-2 Inhibitors After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of
Norman H Y Lin1, Jamie S Y Ho1, Aloysius S T Leow1
1Department of Medicine, National University Hospital, Singapore, Singapore.
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce heart failure hospitalizations in post-acute myocardial infarction (post-AMI) patients. SGLT2i did not significantly impact mortality, but lowered NT-proBNP levels.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Global rise in cardiovascular disease, with ischemic heart disease as a leading cause of mortality.
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) show cardiovascular benefits in heart failure patients.
- Limited evidence on SGLT2i initiation in post-acute myocardial infarction (post-AMI) patients.
Purpose of the Study:
- To systematically review the literature on the effects of SGLT2i on clinical outcomes in post-AMI patients.
- To evaluate the efficacy and safety of SGLT2i in the acute post-AMI setting.
Main Methods:
- Comprehensive literature search of PubMed, EMBASE, SCOPUS, and ClinicalTrials.gov up to May 1, 2024.
- Inclusion of randomized controlled trials (RCTs) involving adult post-AMI patients initiated on SGLT2i.
- Exclusion of studies focusing solely on heart failure populations.
Main Results:
- Eight RCTs with 11,436 patients were included.
- SGLT2i significantly reduced heart failure hospitalizations (RR 0.74, 95% CI 0.62-0.90) compared to placebo.
- SGLT2i was associated with lower NT-proBNP levels, but no significant differences in all-cause mortality, cardiovascular mortality, LVEF, or HbA1c.
Conclusions:
- SGLT2i initiation in post-AMI patients reduces heart failure hospitalizations and NT-proBNP levels.
- No significant impact on mortality outcomes was observed.
- SGLT2i may be beneficial for managing post-AMI patients at risk for heart failure.
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