Sodium-Glucose Cotransporter-2 Inhibitors Following Acute Myocardial Infarction in Patients Without Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Background Sodium-glucose transporter 2 (SGLT2) inhibitors have shown significant cardiovascular benefits in heart failure (HF) patients with diabetes mellitus or chronic kidney disease. However, their safety and efficacy in non-diabetic patients without HF presenting with acute myocardial infarction (AMI) remain understudied. Methods Databases including MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov were queried through August 2025 to identify randomized controlled trials (RCTs). Data were pooled using a random-effects model using risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Results Five RCTs involving 9,135 patients (SGLT2i: 4,581 and placebo: 4,554) were included. On pooled analysis, SGLT2 inhibitors were associated with significantly reduced first HF hospitalization (RR: 0.74, p=0.02), improved LVEF (MD: 2.08; p=0.002), and reduced NT-proBNP levels (MD: 12.81; p < 0.0001). No significant differences were noted in all-cause mortality and the composite of first HF hospitalization with all-cause mortality. Conclusion In non-diabetic patients without HF, SGLT2 inhibitors significantly reduce the first HF hospitalization and improve LVEF following AMI. The findings of this meta-analysis suggest that future research should evaluate the cardiovascular benefits of SGLT2 inhibitors in this patient population.