Effects of sodium‐glucose cotransporter‐2 inhibitors in myocardial infarction patients: A systematic review and meta‐analysis

Qiufeng Jia; Ankai Zuo; Hui Song; Chengrui Zhang; Xiangrui Fu; Keqing Hu; Fengshuang An

doi:10.1111/dom.16122

December 18, 2024Diabetes Obesity and MetabolismOpen Access

Effects of sodium‐glucose cotransporter‐2 inhibitors in myocardial infarction patients: A systematic review and meta‐analysis

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Why the study?

SGLT2 inhibitors improve cardiovascular outcomes in heart failure, T2DM, and CKD, but their efficacy following myocardial infarction remains unclear.

Do SGLT2 inhibitors reduce cardiovascular events, mortality, and heart failure hospitalization in post-myocardial infarction patients?

Structured PICO

Do SGLT2 inhibitors reduce cardiovascular events, mortality, and heart failure hospitalization in post-myocardial infarction patients?

P

Population

22,370 post-myocardial infarction patients pooled from 13 studies

I

Intervention

Sodium-glucose cotransporter-2 (SGLT2) inhibitors as a class

O

Outcome

Hospitalization for heart failure (HHF), cardiovascular (CV) death, a composite of HHF or CV death, all-cause death, major cardiovascular events (MACE), recurrent MI, severe arrhythmia, renal injury and strokecomposite

SGLT2 inhibitors significantly reduce the risk of heart failure hospitalization, cardiovascular death, and all-cause mortality, while improving left ventricular function in patients following a myocardial infarction.

Implication

Supports SGLT2 inhibitor use after MI to lower heart failure and mortality risk; extends benefits to post-MI patients beyond diabetes or established HF.

Abstract

AIMS: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are known to improve cardiovascular outcomes in individuals with heart failure (HF), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). However, their efficacy following myocardial infarction (MI) remains unclear. MATERIALS AND METHODS: A systematic search was conducted using PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov. Primary outcomes included hospitalization for heart failure (HHF), cardiovascular (CV) death, a composite of HHF or CV death, all-cause death, major cardiovascular events (MACE), recurrent MI, severe arrhythmia, renal injury and stroke. Secondary outcomes targeted improvements in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV). RESULTS: Thirteen studies comprising 22 370 patients were included. Meta-analysis revealed that SGLT2 inhibitors reduced HHF (RR 0.69, 95% CI 0.61 to 0.78, p < 0.001), combined HHF or CV death (RR 0.87, 95% CI 0.77 to 0.99, p = 0.028), all-cause mortality (RR 0.82, 95% CI 0.73 to 0.93, p = 0.002), MACE (RR 0.68, 95% CI 0.53 to 0.88, p = 0.004), recurrent MI (RR 0.81, 95% CI 0.69 to 0.94, p = 0.007), severe arrhythmia (RR 0.54, 95% CI 0.34 to 0.85, p = 0.009) and renal injury (RR 0.68, 95% CI 0.53 to 0.87, p = 0.002). Improvement in LVEF (MD 3.96%, 95% CI 2.52 to 5.40; p < 0.001) and LVEDV (MD -5.52 mL, 95% CI -10.21 to -0.83; p = 0.021) was notably greater in the SGLT2 inhibitors group. CONCLUSIONS: In post-MI patients, we first found that SGLT2 inhibitors significantly lowered the risk of HHF, combined CV death or HHF, all-cause death, MACE, recurrent MI, severe arrhythmias and renal injury. Additionally, SGLT2 inhibitors improved LVEF and LVEDV.