The clinical efficacy and safety of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in patients with acute myocardial infarction; a meta-analysis of randomized controlled trials

Objective Sodium-glucose co-transporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in patients with heart failure (HF), but the evidence of their efficacy in patients who have had an acute myocardial infarction (AMI) is still incompletely established. This review aimed to assess the safety and efficacy of SGLT2 inhibitors on cardiovascular and structural outcomes in patients who had a recent AMI, irrespective of HF. Methods: We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov till February 2025 to retrieve randomized controlled trials comparing SGLT2 inhibitors to placebo in patients with AMI. We performed a statistical analysis on RevMan 5.4 using the random effect model. Results: Our meta-analysis included seven RCTs involving 11,302 patients compared SGLT2 inhibitors to placebo in patients with AMI. SGLT2 inhibitors significantly decreased the rate of hospitalization for HF (RR 0.73, 95% CI: 0.61-0.88) with no significant change in mortality (RR 1.05, 95% CI: 0.78-1.40), all-cause hospitalization (RR 1.00, 95% CI: 0.84-1.17), and cardiovascular death (RR 1.03, 95% CI: 0.83-1.28). The incidence of hepatic injury, ketoacidosis, hypoglycemia, or lower limb amputation remained comparable across the two groups. SGLT2 inhibitors did not cause a significant reduction in N-terminal pro–B-type natriuretic peptide (NT-pro BNP) from baseline (MD −0.28 95% CI: − 0.61-0.05) nor improved the left ventricular ejection fraction (LVEF) at follow-up (MD 0.62, 95% CI −0.73-1.97) compared to the placebo. Conclusion: In conclusion, while SGLT2 inhibitors show promise in reducing hospitalization for HF post-AMI, their impact on mortality and safety outcomes necessitates further investigation. This underscores the need for larger, more diverse RCTs to fully illustrate their role and timing of initiation in AMI management. An individualized approach based on risk assessment should guide their use in the post-AMI population.