Photo Credit: lawanastudio

The following is a summary of “Impact of sodium-glucose cotransporter‐2 inhibitors in patients with recent versus previous myocardial infarction: a systematic review and meta-analysis,” published in the February 2025 issue of the Cardiovascular Diabetology by Scardini et al.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been incorporated into heart failure (HF) management guidelines due to their demonstrated efficacy in reducing mortality and hospitalizations. However, the optimal timing for initiating SGLT2 inhibitors in patients following myocardial infarction (MI) remains uncertain. This systematic review and meta-analysis aimed to evaluate the efficacy of SGLT2 inhibitors compared to placebo in patients with recent or prior MI, focusing on their impact on HF-related outcomes and overall cardiovascular health. A comprehensive literature search was conducted across PubMed, Cochrane, and Embase to identify RCTs assessing the effects of SGLT2 inhibitors versus placebo in patients post-MI. 

The primary outcome was hospitalization for HF, while secondary outcomes included major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, MI, or stroke, as well as all-cause mortality. A subgroup analysis was performed to compare the effects of SGLT2 inhibitors in patients with acute MI (within eight weeks) versus those with previous MI (more than eight weeks prior). RRs and 95% CIs were calculated using a random-effects model. The final meta-analysis incorporated data from 10 RCTs, comprising a total of 22,266 patients, 51.2% of whom had type 2 diabetes. The mean patient age was 62 years, with a median follow-up duration of 21 months. The pooled analysis demonstrated a significant reduction in HF hospitalization rates among patients receiving SGLT2 inhibitors compared to placebo (RR 0.77; 95% CI 0.69–0.85; p < 0.001). Additionally, SGLT2 inhibitors were associated with a decreased incidence of MACE (RR 0.88; 95% CI 0.79–0.97; p = 0.012). 

However, no statistically significant difference was observed in all-cause mortality between the treatment and placebo groups (RR 0.88; 95% CI 0.78–1.00; p = 0.058). Notably, the benefits of SGLT2 inhibitors on HF hospitalization were consistent across subgroups, irrespective of whether patients were treated in the acute or previous MI setting (p for interaction = 0.56). These findings suggest that SGLT2 inhibitors confer a significant protective effect against HF-related hospitalizations in patients post-MI, with consistent efficacy regardless of the timing of treatment initiation. Given the substantial clinical impact of HF following MI, these results support the early incorporation of SGLT2 inhibitors into post-MI management strategies. Further large-scale studies are warranted to refine treatment protocols and optimize patient outcomes.

Source:cardiab.biomedcentral.com/articles/10.1186/s12933-024-02540-4