Key result
Delaying SGLT2i initiation post-discharge linked to ~50% higher MACE risk after ACS in T2D.
Why the study?
Sodium-glucose co-transporter 2 inhibitors provide cardiovascular benefits in type 2 diabetes mellitus, but the optimal timing of initiation in patients with acute coronary syndrome was not known.
Does early initiation of sodium-glucose co-transporter 2 inhibitors at hospital discharge reduce major adverse cardiovascular events compared to delayed or no therapy in patients with type 2 diabetes and acute coronary syndrome?
Cohort (n=970)
No
Does early initiation of sodium-glucose co-transporter 2 inhibitors at hospital discharge reduce major adverse cardiovascular events compared to delayed or no therapy in patients with type 2 diabetes and acute coronary syndrome?
Initiating SGLT2 inhibitor therapy at hospital discharge in patients with type 2 diabetes and acute coronary syndrome is associated with a significantly lower risk of major adverse cardiovascular events compared to delayed post-discharge initiation or no therapy.
Early SGLT2i at discharge may reduce MACE in T2DM with ACS; leaves open confirmation by randomized trials.
AIMS: Sodium-glucose co-transporter 2 inhibitors have demonstrated cardiovascular benefits in individuals with type 2 diabetes mellitus, but the optimal timing of initiation in those with acute coronary syndrome is not known. This study aims to assess if early therapy at discharge is superior to delayed or no therapy in reduction in major adverse cardiovascular events. METHODS: This retrospective, observational cohort study included individuals with type 2 diabetes admitted with an acute coronary syndrome at a single regional heart centre between July 2018 and December 2023. Individuals were stratified into three groups based on the timing of sodium-glucose co-transporter 2 inhibitor initiation: (1) discharge group (initiated at hospital discharge), (2) post-discharge group (initiated after discharge during follow-up) and (3) no therapy group. The primary outcome was the first occurrence of a major adverse cardiovascular event. RESULTS: Among 970 eligible patients (median age, 70.2 years [IQR, 61.0-78.5 years]; 73.9% male), the median follow-up duration was 29.9 months (IQR, 20.1, 43.0 months). Compared with the discharge group, the risk of primary outcome was significantly higher in both the post-discharge group (adjusted hazard ratio [aHR], 1.50; 95% CI [1.13, 1.99], p = 0.005) and the no therapy group (aHR, 1.65; 95% CI [1.24, 2.20]; p < 0.001). Analyses were adjusted using clone-censor-weight methods and multivariable Cox-proportional hazards models. CONCLUSIONS: Sodium-glucose co-transporter 2 inhibitor therapy at hospital discharge was associated with a significantly lower risk of major adverse cardiovascular events in patients with type 2 diabetes and acute coronary syndrome.
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Shah et al. (2026) conducted a cohort in Type 2 diabetes mellitus and acute coronary syndrome (n=970). Sodium-glucose co-transporter 2 inhibitor initiation at hospital discharge vs. Post-discharge initiation or no SGLT2 inhibitor therapy was evaluated on First occurrence of a major adverse cardiovascular event (aHR 1.50 (post-discharge vs discharge); aHR 1.65 (no therapy vs discharge), 95% CI 1.13-1.99, p=0.005). Delaying SGLT2i initiation until post-discharge (aHR 1.50, 95% CI 1.13-1.99) or giving no therapy (aHR 1.65, 95% CI 1.24-2.20) increased MACE risk vs discharge initiation in T2D with ACS.
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