Administration of Sodium-Glucose Cotransporter-2 Inhibitors Following Acute Myocardial Infarction: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Trials

Abstract

Objective: Individuals with acute myocardial infarction (AMI) face a considerable mortality risk. Recent evidence suggests that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) may provide cardioprotective benefits, particularly in cases of heart failure (HF). However, the evidence regarding SGLT-2i use in AMI patients remains contradictory and ambiguous. This study investigates the efficacy and safety of SGLT-2i administration following AMI. Methods: We systematically searched Scopus, Cochrane Library, MEDLINE, and ClinicalTrials.gov for potential articles using specific keywords, with the search extending until December 15th, 2024. All published randomized controlled trials (RCTs) assessing SGLT-2i use following AMI were included. Outcomes were expressed as risk ratios (RRs) and standardized mean differences. Results: A total of 7 RCTs were included. Our pooled analysis demonstrated that SGLT-2i administration post-AMI was associated with a reduced risk of HF hospitalization (RR, 0.72; 95% confidence interval [CI], 0.60, 0.86; p=0.0004, I2=0%) and an improved left ventricular ejection fraction (LVEF) (SMD, 0.29; 95% CI, 0.03, 0.55; p=0.03; I2=60%) compared with placebo. However, there were no significant differences in all-cause mortality (p=0.94), cardiovascular (CV)-related mortality (p=0.77), stroke/transient ischemic attack (p=0.17), or major adverse CV events (p=0.16). The incidences of serious adverse events, diabetic ketoacidosis, and urinary tract infections were comparable between the 2 groups. Conclusion: The administration of SGLT-2i following AMI may reduce the risk of HF hospitalization and improve LVEF, without affecting mortality outcomes. Overall, SGLT-2i proved to be a comparatively safe treatment option. Trial Registration PROSPERO Identifier: CRD42024627125