Key result
SGLT2 inhibitor prescription at discharge in survivors of AMI with cardiogenic shock was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749; 95% CI 0.462-1.215; p=0.241).
Why the study?
SGLT2 inhibitors improve cardiovascular outcomes in heart failure and after MI, but patients with cardiogenic shock have been excluded from major trials.
Does SGLT2 inhibitor prescription at discharge reduce 1-year cardiac death and heart failure events in survivors of acute myocardial infarction complicated by cardiogenic shock?
Cohort (n=826)
Yes
Does SGLT2 inhibitor prescription at discharge reduce 1-year cardiac death and heart failure events in survivors of acute myocardial infarction complicated by cardiogenic shock?
In survivors of AMI complicated by cardiogenic shock, discharge prescription of SGLT2 inhibitors was associated with a non-significant numerical reduction in 1-year cardiac death, highlighting the need for dedicated randomized trials in this high-risk population.
Answers are grounded in this paper and cite their sources.
SGLT2 inhibitor discharge prescription was associated with non-significant cardiac death reduction after AMI shock; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure and after myocardial infarction (MI), but patients with cardiogenic shock (CS) have been excluded from major trials. We therefore evaluated the association between discharge SGLT2 inhibitor prescription and 1-year outcomes in survivors of acute myocardial infarction (AMI) complicated by CS. METHODS: This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models. RESULTS: Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629-1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients. CONCLUSIONS: In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.
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Daoulah et al. (2026) conducted a cohort in Acute myocardial infarction complicated by cardiogenic shock (n=826). SGLT2 inhibitors vs. Standard therapy was evaluated on 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241). SGLT2 inhibitor prescription at discharge in survivors of AMI with cardiogenic shock was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749; 95% CI 0.462-1.215; p=0.241).
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