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Background Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve clinical outcomes in patients with heart failure; however, their efficacy and safety in patients with myocardial infarction, particularly when used in addition to conventional therapy, remain controversial. Therefore, this study aims to evaluate the effects of adding SGLT2i to conventional therapy on clinical outcomes in patients with myocardial infarction through a systematic review and meta-analysis. Methods We conducted a systematic review and meta-analysis to compare the effects of conventional therapy with or without SGLT2i on clinical outcomes in patients with myocardial infarction. PubMed, Web of Science, the Cochrane Library, and Embase were systematically searched. The primary outcome was the incidence of hospitalization for heart failure. Secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), left ventricular ejection fraction (LVEF), N-terminal pro-B type natriuretic peptide (NT-proBNP), and low-density lipoprotein cholesterol (LDL-C). Safety outcomes comprised renal dysfunction, hepatic dysfunction, urinary tract infection, and glycemia-related adverse events. All analyses were conducted using a random-effects model. Prespecified subgroup analyses for the primary outcome were performed according to the presence or absence of type 2 diabetes mellitus, timing of SGLT2i initiation, and specific SGLT2i agent. Results This meta-analysis included 13 randomized controlled trials involving 22,238 patients with myocardial infarction. Compared with conventional therapy alone, treatment with SGLT-2i significantly reduced the incidence of hospitalization for heart failure (RR = 0.76, 95% CI 0.68–0.84, p 0.00001). For key secondary outcomes, the use of SGLT2i was not associated with all-cause mortality (RR = 0.87, 95% CI 0.75–1.01, p = 0.06), but was associated with a significant reduction in the risk of major adverse cardiovascular events (MACE) (RR = 0.84, 95% CI 0.73–0.98, p = 0.03). However, no significant difference was observed between the two groups in cardiovascular mortality (RR = 0.87, 95% CI 0.61–1.24, p = 0.44). In addition, SGLT2i combined with conventional therapy significantly improved left ventricular ejection fraction (MD = 3.45, 95% CI 0.67–6.24, p = 0.02) and significantly reduced NT-proBNP levels (MD = −311.99, 95% CI −666.00–15.23, p = 0.04). In terms of safety outcomes, the use of SGLT2i was associated with a reduced risk of renal dysfunction (RR = 0.77, 95% CI 0.66–0.89, p = 0.0006) and glycemia-related adverse events (RR = 0.56, 95% CI 0.40–0.80, p = 0. 001). No significant increase was observed in the risk of urinary tract infection (RR = 1.73, 95% CI 0.76–3.97, p = 0.12; P = 0.19) or hepatic dysfunction (RR = 2.46, 95% CI 0.86–6.98, p = 0.09; P = 0.49). Prespecified subgroup analyses showed that the treatment benefit for the primary outcome was generally consistent irrespective of the presence or absence of type 2 diabetes mellitus or the specific SGLT2i agent used. Conclusion In this meta-analysis, the addition of SGLT2i to standard therapy following myocardial infarction was associated with a reduction in hospitalization for heart failure, as well as a lower incidence of renal dysfunction and glycemia-related adverse events. Furthermore, favorable effects of SGLT2i were observed in patients with MI irrespective of the presence or absence of type 2 diabetes mellitus or the specific SGLT2i agent used. Systematic Review Registration PROSPERO CRD420251129087.
Xu et al. (Tue,) studied this question.