In adults with AMI undergoing PCI, GLP-1 RA initiation was associated with a lower 1-year risk of MACE compared to SGLT2 inhibitors (HR 0.788; 95% CI 0.706-0.881).
Cohort (n=11,453)
Yes
Does GLP-1 RA initiation compared to SGLT2i initiation improve clinical outcomes in adults with AMI undergoing PCI?
In a real-world cohort of patients with AMI undergoing PCI, initiation of GLP-1 RAs within 14 days was associated with lower risks of adverse cardiovascular outcomes at 1 year compared to SGLT2 inhibitors.
Hazard Ratio: 0.788 (95% CI 0.706–0.881)
BACKGROUND: No head-to-head trials have directly compared GLP-1 receptor agonists (GLP‑1 RAs) and SGLT2 inhibitors (SGLT2is) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). AIMS: To compare short-, mid-, and long-term clinical outcomes of GLP-1 RAs versus SGLT2 inhibitors in adults with AMI undergoing PCI, using a multicenter propensity score-matched real-world cohort from the TriNetX US Collaborative Network. METHODS: This multicenter, retrospective cohort study used de-identified data from the TriNetX US Collaborative Network. Adults with AMI who underwent PCI and initiated either GLP‑1 RAs (n = 7201) or SGLT2is (n = 4252) within 14 days were included. One-to-one greedy nearest-neighbor propensity score matching (caliper 0.1) yielded balanced cohorts across > 50 covariates, resulting in 1752 patients per group. Kaplan-Meier and Cox models assessed mortality, heart failure, hospitalization, recurrent myocardial infarction (RMI), stroke, atrial fibrillation, major adverse cardiovascular events (MACE), acute kidney injury (AKI), and cardiac arrest. RESULTS: Compared with SGLT2is, GLP-1 RAs were associated with lower 1-year risks of acute heart failure (HR 0.415 0.343-0.501), all-cause hospitalization (HR 0.559 0.495-0.631), RMI (HR 0.799 0.710-0.899), stroke (HR 0.800 0.667-0.959), atrial fibrillation (HR 0.804 0.693-0.932), MACE (HR 0.788 0.706-0.881), and AKI (HR 0.534 0.444-0.643). At 30 days, absolute risk reduction was lower with GLP-1 RAs for acute heart failure (7.19% 5.66%-8.72%) and all-cause hospitalization (16.61% 14.24%-18.98%). All-cause mortality did not differ at 30 or 90 days but was lower at 1 year (HR 0.700 0.507-0.967). Cardiac arrest did not differ significantly. CONCLUSIONS: In this real-world, propensity score-matched study of patients with AMI undergoing PCI, GLP-1 RA initiation linked to lower risk of short- and long-term adverse outcomes than SGLT2i. These are observational findings needing confirmation in randomized trials.
Khalil et al. (2026) conducted a cohort in Acute myocardial infarction undergoing percutaneous coronary intervention (n=11,453). GLP-1 receptor agonists vs. SGLT2 inhibitors was evaluated on Major adverse cardiovascular events (MACE) at 1 year (HR 0.788, 95% CI 0.706-0.881). In adults with AMI undergoing PCI, GLP-1 RA initiation was associated with a lower 1-year risk of MACE compared to SGLT2 inhibitors (HR 0.788; 95% CI 0.706-0.881).