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Pre-PCI SGLT2 inhibitors and contrast-induced nephropathy in acute myocardial infarction: A meta-analysis
Yue Li1, Wanyao Zhang1, Rui Li2
1Department of Cardiology, The People's Hospital of Rongchang District, Chongqing, China.
Insights
Pre-procedural sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduced contrast-induced nephropathy (CIN) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). This intervention also lowered mortality, major adverse cardiovascular events, and heart failure readmissions.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication of percutaneous coronary intervention (PCI), particularly in acute myocardial infarction (AMI) patients.
- CIN increases hospital stays, healthcare costs, and is associated with poor prognosis.
Purpose of the Study:
- To evaluate the preventive efficacy of pre-procedural sodium-glucose cotransporter-2 (SGLT2) inhibitors on CIN incidence.
- To assess the impact of SGLT2 inhibitors on secondary outcomes including mortality, MACE, and HF readmission in PCI-treated AMI patients.
Main Methods:
- A systematic literature search was conducted across PubMed, Web of Science, and Cochrane Library up to December 12, 2024.
- Included were observational studies and clinical trials on pre-procedural SGLT2 inhibitors in PCI-treated AMI patients, adhering to PRISMA guidelines.
- Data synthesis used a random-effects model, analyzing CIN incidence, all-cause mortality, MACE, recurrent MI, and HF readmission.
Main Results:
- Five studies with 3301 patients were analyzed, showing significantly lower CIN incidence with SGLT2 inhibitors (RR: 0.55, P<0.0001).
- SGLT2 inhibitors also significantly reduced all-cause mortality (RR: 0.49, P=0.005), MACE (RR: 0.33, P=0.01), and HF readmission (RR: 0.30, P=0.0001).
- No significant difference was found in recurrent myocardial infarction rates (RR: 0.88, P=0.77).
Conclusions:
- Pre-procedural SGLT2 inhibitors demonstrate significant protective effects against CIN in PCI-treated AMI patients.
- The findings suggest potential cardiorenal protective benefits of SGLT2 inhibitors in this patient population.
- SGLT2 inhibitors may be a valuable strategy for improving outcomes in AMI patients undergoing PCI.
Background:
Contrast-induced nephropathy (CIN), a common complication of percutaneous coronary intervention (PCI), adversely affects clinical outcomes by extending hospital stays and increasing healthcare costs. Importantly, CIN is linked to poor prognosis in acute myocardial infarction (AMI) patients. This study evaluated the preventive effect of pre-procedural sodium-glucose cotransporter-2 (SGLT2) inhibitors administration on CIN incidence in AMI patients who received PCI.
Methods:
A systematic search of PubMed, Web of science, and the Cochrane Library was performed for studies published up to December 12, 2024. Observational studies and clinical trials investigating pre-procedural SGLT2 inhibitors use in PCI-treated AMI patients were included. Following PRISMA guidelines, 2 researchers independently screened the literature, extracted the data, and assessed the bias risk. Data synthesis utilized Review Manager 5.3 with a random-effects model to address heterogeneity. The primary outcomes included CIN incidence (95% confidence intervals (CI)). The secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), recurrent myocardial infarction, and heart failure (HF) readmission, which were analyzed via risk ratios(RR) and I² statistics.
Results:
Five studies involving 3301 patients (SGLT2 inhibitors group: 665; control: 2636) were analyzed. Compared with the control group, the SGLT2 inhibitors group demonstrated significantly lower risks of CIN (RR: 0.55, 95% CI: 0.41-0.73, P < .0001), all-cause mortality (RR: 0.49, 95% CI: 0.29-0.81, P = .005), MACE (RR: 0.33, 95% CI: 0.17-0.65, P = .01), and HF readmission (RR: 0.30, 95% CI: 0.16-0.56, P = .0001). No significant difference was observed in the recurrent myocardial infarction rates (RR: 0.88, 95% CI: 0.38-2.06, P = .77).
Conclusion:
Pre-procedural SGLT2 inhibitors use significantly reduces CIN incidence, mortality, MACE, and HF readmission in PCI-treated AMI patients, suggesting potential cardiorenal protective benefits.
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