Effects of SGLT2 inhibitors on acute myocardial infarction: A systematic review and meta-analysis

Background: Current treatment guidelines and expert consensus are controversial regarding the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) during acute progression of acute myocardial infarction (AMI) .Therefore, we conducted a systematic review and meta-analysis to evaluate the impact of SGLT2i on AMI , and safety outcomes in patients. Methods: PubMed, Web of Science, Embase, China Science and Technology Journal Database, Wan fang Database and China National Knowledge Infrastructure Database were searched for clinical trials from database establishment to December 31，2023 with no language restrictions. The risk of bias was evaluated by Collaboration Handbook. Review Manager (version 5.3) were used for meta-analysis. Results: A total of nine articles including 16083 patients were included. In patients with AMI, SGLT2i reduced the risk of the cardiovascular-death (RR 0.64, 95% CI 0.53–0.78, P <0.0001, I ² =32% for the heterogeneity), hospitalization rate for heart failure (RR 0.69, 95% CI 0.53–0.90, P =0.006), arrhythmia (RR 0.53, 95% CI 0.33–0.86, P =0.009). No significant differences were observed between the two groups with regard to all-cause deaths(RR 0.72, 95% CI 0.51–1.01, P=0.06), recurrence rate of myocardial infarction(RR 0.94, 95% CI 0.80–1.10, P=0.43), unplanned revascularization rate(RR 1.10, 95% CI 0.74–1.65, P=0.63)，and with similar risks of adverse events(RR 0.61, 95% CI 0.32–1.16, P=0.13)( such as acute kidney injury was lower than that of control group, genital infection was higher than that of control group). Conclusions: This meta-analysis of patients with AMI showed that SGLT2i significantly reduce the risk of cardiovascular death , hospitalization and arrhythmia for AMI, but not recurrence rate of myocardial infarction, unplanned revascularization rate and all-cause death. Therefore, given that SGLT2i may reduce the risk of hospitalization and cardiovascular death for AMI, they should be considered the fundamental treatment for all patients with AMI.