Key result
Early SGLT2 inhibitors cut heart failure hospitalization ~25% after acute MI vs. placebo.
Why the study?
No meta-analysis had holistically analysed the potential benefits and safety of early initiation of SGLT2 inhibitors in patients with acute myocardial infarction.
Does early initiation of SGLT2 inhibitors reduce cardiovascular death, all-cause death, and heart failure hospitalization in patients with acute myocardial infarction?
Meta-Analysis (n=7,409)
Does early initiation of SGLT2 inhibitors reduce cardiovascular death, all-cause death, and heart failure hospitalization in patients with acute myocardial infarction?
Odds Ratio: 0.75 (95% CI 0.62–0.9)
p-value: p=0.002
Early initiation of SGLT2 inhibitors within 2 weeks of an acute myocardial infarction safely reduces the risk of subsequent heart failure hospitalization.
Reduces HHF after acute MI; extends SGLT2i evidence from chronic HF to post-MI patients.
ackground.Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are the preferred agents for managing type 2 diabetes in patients with established atherosclerotic cardiovascular disease and for reducing hospitalization for heart failure (HHF) in patients with heart failure with reduced and preserved ejection fraction.We undertook this meta-analysis, as, to date, no meta-analysis has holistically analysed the potential benefits and safety of SGLT2i in patients with acute myocardial infarction (MI).Methods.Electronic databases were searched for randomized controlled trials (RCTs) involving patients with MI who received SGLT2i in the intervention arm (initiated within 2 weeks of the index event) and placebo/active comparator in the control arm.The primary outcome was to evaluate the impact on cardiovascular death, all-cause death and HHF.The secondary outcomes were to evaluate the impact on echocardiographic parameters, N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, MI, stroke, all-cause hospitalization and safety issues.Results.From initially screened 8,922 articles, data from 6 RCTs were analysed (7,409 patients).Early initiation of SGLT2i following MI was associated with significantly lower future HHF (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.62-0.90;p=0.002;I 2 =0%) and significantly higher left-ventricular ejection fraction (mean difference [MD]: 1.65%; 95% CI: 0.34-2.96;p=0.01;I 2 =0%) compared with placebo.Compared with placebo, SGLT2i following MI had no beneficial impact on cardiovascular deaths (OR: 1.04; 95% CI: 0.83-1.30;p=0.76;I 2 =0%), all-cause mortality (OR: 1.00; 95% CI: 0.82-1.21;p=0.98;I 2 =0%), stroke (OR: 0.58; 95% CI: 0.26-1.27;p=0.17), all-cause hospitalization (OR: 1.13; 95% CI: 0.97-1.32;p=0.11;I 2 =0%) and percentage change in NT-proBNP (MD: 1.18%; 95% CI: -9.78 to 12.14; p=0.83;I 2 =52%).SGLT2i were well tolerated without increased ketoacidosis, acute renal failure or hepatic injury.Conclusion.Early initiation of SGLT2i in acute MI is safe, well tolerated and associated with a reduction in HHF. Article HighlightsEarly use of sodium-glucose co-transporter-2 inhibitors following myocardial infarction was associated with the following factors:
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Dutta et al. (2025) conducted a meta-analysis in Acute Myocardial Infarction (n=7,409). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) vs. Placebo or active comparator was evaluated on Hospitalization for heart failure (OR 0.75, 95% CI 0.62-0.90, p=0.002). Early initiation of SGLT2 inhibitors following acute myocardial infarction significantly reduced hospitalization for heart failure (OR 0.75) compared with placebo.
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