Sodium-Glucose Cotransporter-2 Inhibitors After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Overview

Journal Am J Cardiovasc Drugs

Specialties Cardiology & Vascular Diseases
Pharmacology

Date 2024 Oct 14

PMID 39400908

Authors

Norman H Y Lin

Jamie S Y Ho

Aloysius S T Leow

Yao Hao Teo

Brian S Y Yeo

Audrey A Y Zhang

Fang Qin Goh

Tiong-Cheng Yeo

Raymond C C Wong

Ping Chai

Mark Y Y Chan

Ching-Hui Sia

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular disease is on the rise globally, with ischemic heart disease being the leading cause of mortality and morbidity. While sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve cardiovascular outcomes in patients with heart failure, evidence is limited in guiding initiation in post-acute myocardial infarction (post-AMI) patients. Hence, this study aimed to appraise the current literature on the effect of SGLT2i on the clinical outcomes of post-AMI patients.

Methods: A comprehensive search of PubMed, EMBASE, SCOPUS, and ClinicalTrials.gov was conducted up to 1 May 2024. Only randomized controlled trials studying the use of SGLT2i in post-AMI patients were included. We included adult patients aged 18 years old and older diagnosed with AMI and initiated on SGLT2i in the acute post-AMI setting. SGLT2i studies solely in heart failure settings were excluded.

Results: Eight clinical trials were included in the systematic review, comprising 11,436 patients. Compared with placebo, SGLT2i initiation in post-AMI patients significantly reduced total number of heart failure hospitalizations (risk ratio [RR] 0.74, 95% confidence interval [CI] 0.62-0.90) and was associated with a lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (- 26.67 pg/ml, 95% CI - 41.74 to - 11.59). There was no difference in all-cause mortality (RR 1.02, 95% CI 0.81-1.28), cardiovascular mortality (RR 1.03, 95% CI 0.83-1.28), change in left ventricular ejection fraction, and glycated hemoglobin (HbA1c), as compared with placebo.

Conclusion: SGLT2i use in patients with AMI was associated with a reduction in heart failure hospitalizations and a decrease in NT-proBNP. There were no significant differences in mortality outcomes.

Registration: PROSPERO identifier number CRD42024540843.

References

Khan M, Hashim M, Mustafa H, Baniyas M, Al Suwaidi S, AlKatheeri R . Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020; 12(7):e9349. PMC: 7384703. DOI: 10.7759/cureus.9349. View

Roth G, Mensah G, Johnson C, Addolorato G, Ammirati E, Baddour L . Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020; 76(25):2982-3021. PMC: 7755038. DOI: 10.1016/j.jacc.2020.11.010. View

Frantz S, Hundertmark M, Schulz-Menger J, Bengel F, Bauersachs J . Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies. Eur Heart J. 2022; 43(27):2549-2561. PMC: 9336586. DOI: 10.1093/eurheartj/ehac223. View

Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo A . Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2017; 391(10120):572-580. PMC: 5814791. DOI: 10.1016/S0140-6736(17)32520-5. View

Paolisso P, Bergamaschi L, Gragnano F, Gallinoro E, Cesaro A, Sardu C . Outcomes in diabetic patients treated with SGLT2-Inhibitors with acute myocardial infarction undergoing PCI: The SGLT2-I AMI PROTECT Registry. Pharmacol Res. 2022; 187:106597. PMC: 9946774. DOI: 10.1016/j.phrs.2022.106597. View

James S, Erlinge D, Storey R, McGuire D, de Belder M, Eriksson N . Dapagliflozin in Myocardial Infarction without Diabetes or Heart Failure. NEJM Evid. 2024; 3(2):EVIDoa2300286. DOI: 10.1056/EVIDoa2300286. View

Butler J, Jones W, Udell J, Anker S, Petrie M, Harrington J . Empagliflozin after Acute Myocardial Infarction. N Engl J Med. 2024; 390(16):1455-1466. DOI: 10.1056/NEJMoa2314051. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

Haddaway N, Page M, Pritchard C, McGuinness L . : An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2023; 18(2):e1230. PMC: 8958186. DOI: 10.1002/cl2.1230. View

10.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A . Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1):210. PMC: 5139140. DOI: 10.1186/s13643-016-0384-4. View

11.

Zinman B, Wanner C, Lachin J, Fitchett D, Bluhmki E, Hantel S . Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015; 373(22):2117-28. DOI: 10.1056/NEJMoa1504720. View

12.

Mahaffey K, Neal B, Perkovic V, de Zeeuw D, Fulcher G, Erondu N . Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation. 2017; 137(4):323-334. PMC: 5777572. DOI: 10.1161/CIRCULATIONAHA.117.032038. View

13.

Wiviott S, Raz I, Bonaca M, Mosenzon O, Kato E, Cahn A . Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2018; 380(4):347-357. DOI: 10.1056/NEJMoa1812389. View

14.

McMurray J, Solomon S, Inzucchi S, Kober L, Kosiborod M, Martinez F . Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019; 381(21):1995-2008. DOI: 10.1056/NEJMoa1911303. View

15.

Packer M, Anker S, Butler J, Filippatos G, Pocock S, Carson P . Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020; 383(15):1413-1424. DOI: 10.1056/NEJMoa2022190. View

16.

Solomon S, McMurray J, Claggett B, de Boer R, DeMets D, Hernandez A . Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022; 387(12):1089-1098. DOI: 10.1056/NEJMoa2206286. View

17.

Anker S, Butler J, Filippatos G, Ferreira J, Bocchi E, Bohm M . Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021; 385(16):1451-1461. DOI: 10.1056/NEJMoa2107038. View

18.

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. View

19.

Pfeffer M, Claggett B, Lewis E, Granger C, Kober L, Maggioni A . Angiotensin Receptor-Neprilysin Inhibition in Acute Myocardial Infarction. N Engl J Med. 2021; 385(20):1845-1855. DOI: 10.1056/NEJMoa2104508. View

20.

Watanabe H, Ozasa N, Morimoto T, Shiomi H, Bingyuan B, Suwa S . Long-term use of carvedilol in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. PLoS One. 2018; 13(8):e0199347. PMC: 6112626. DOI: 10.1371/journal.pone.0199347. View