Efficacy of SGLT2i and GLP-1RA in Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials
Huilei Zhao1, Fuwei Liu2, Jiayu Zhang2
1Department of Anesthesiology, the People's Hospital of Nanchang (the Third Hospital of Nanchang), Nanchang, China.
Introduction:
The efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in acute myocardial infarction (AMI) remains uncertain. We aimed to investigate the effectiveness of SGLT2i and GLP-1RA in patients with AMI.
Methods:
We conducted a comprehensive search on PubMed, the Cochrane Library, Embase, and ClinicalTrials.gov databases to identify relevant randomized controlled trials (RCTs) up to January 2025. The primary outcomes included all-cause mortality and left ventricular ejection fraction (LVEF).
Results:
Six RCTs assessed SGLT2i (SGLT2i: n=5,660; placebo: n=5,651) and five assessed GLP-1RA (GLP-1RA: n=300; placebo: n=333). Compared with placebo, SGLT2i improved LVEF (mean difference = 1.58, p = 0.01, high certainty) and reduced heart failure hospitalization (HHF) (odds ratio = 0.78, p = 0.023, moderate certainty) in AMI patients. No significant benefit was observed in all-cause mortality with SGLT2i, and no significant benefits of GLP-1RA were observed in all-cause mortality, cardiac death, myocardial infarction relapse, infarct size, LVEF, left ventricular end-diastolic volume, or left ventricular end-systolic volume. TSA indicated potential false positives for the LVEF and HHF findings with SGLT2i.
Discussion:
Several limitations of the included studies include a small number of studies, heterogeneity in experimental design, and reliance on alternative endpoints.
Conclusion:
SGLT2i improved LVEF and reduced HHF in patients with AMI but did not significantly improve all-cause mortality. GLP-1RA did not significantly improve LVEF or major clinical endpoints. Further large-scale RCTs are needed to verify these results and provide more robust evidence.
Related Concept Videos
Glucagon-like Receptor Agonists
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
Dipeptidyl Peptidase 4 Inhibitors
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
Acarbose and miglitol are typically...
Oral Hypoglycemic Agents: Biguanides and Glitazones
Acute Coronary Syndrome IV: Interprofessional Care
Oral Hypoglycemic Agents: Glinides
