SGLT2i improved LVEF (MD 1.58, p=0.01) and reduced heart failure hospitalization (OR 0.78, p=0.023) in AMI patients, whereas GLP-1RA showed no significant benefits on major clinical endpoints.
Meta-Analysis (n=11,944)
Do SGLT2i and GLP-1RA improve all-cause mortality and LVEF in patients with acute myocardial infarction compared to placebo?
In patients with acute myocardial infarction, SGLT2 inhibitors improve LVEF and reduce heart failure hospitalizations but do not reduce all-cause mortality, while GLP-1RAs show no significant clinical benefits.
Estimación del efecto: MD 1.58
valor p: p=0.01
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.
Zhao et al. (Mon,) conducted a meta-analysis in acute myocardial infarction (n=11,944). SGLT2i and GLP-1RA vs. placebo was evaluated on all-cause mortality and left ventricular ejection fraction (LVEF) (MD 1.58, p=0.01). SGLT2i improved LVEF (MD 1.58, p=0.01) and reduced heart failure hospitalization (OR 0.78, p=0.023) in AMI patients, whereas GLP-1RA showed no significant benefits on major clinical endpoints.
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