SGLT-2 Inhibitors After Acute Coronary Syndrome As Preventive Approach for Heart Failure-Related Complications: A Meta-Analysis

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have proven to be highly effective in the treatment of heart failure (HF), but their role in preventing stroke, cardiac death, or worsening heart failure events in patient's postacute coronary syndrome remains unclear. This meta-analysis evaluates whether SGLT-2 inhibitors improve cardiovascular outcomes in this setting. A comprehensive search of PubMed, Embase, and the Cochrane database was conducted for studies published up to December 2024, identifying 10 studies, 7 randomized controlled trials (RCTs), and 3 cohort studies, which compared the use of SGLT-2 inhibitors initiated after ACS versus placebo in patients hospitalized for acute coronary syndrome with at least 1 additional risk factor for heart failure hospitalization or adverse cardiovascular outcomes. Following PRISMA guidelines, the meta-analysis (PROSPERO registration: CRD42024543392) included data from 15,114 patients (6826 receiving SGLT-2 inhibitors and 8288 receiving placebo). SGLT-2 inhibitors significantly reduced the risk of first HF hospitalization (RR = 0.78, 95% CI, 0.66-0.92, P = 0.003) and stroke (RR = 0.56, 95% CI, 0.35-0.90, P = 0.02), with low heterogeneity (I 2 = 0%). A significant reduction in cardiac death was also observed (RR = 0.84, 95% CI, 0.74-0.96, P = 0.0009), though this was driven mainly by observational studies. No significant effect was found for all-cause mortality. Subgroup analyses showed that empagliflozin significantly reduced HF hospitalization risk, while dapagliflozin did not. These findings suggest that the use of SGLT-2 inhibitors as part of postacute coronary syndrome management lowers the risk of heart failure hospitalization, cardiac death, and stroke.