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Review
. 2024 Apr 11;16(4):e58019.
doi: 10.7759/cureus.58019. eCollection 2024 Apr.

The Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors on Cardiovascular Outcomes and All-Cause Mortality in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Tanya Sinha  1 , Faria Khilji  2   3 , Fnu Laraib  4 , Farhana Fatima  5 , Mandeep Kaur  6 , Sandipkumar S Chaudhari  7   8 , Divine Besong Arrey Agbor  9   10 , Areeba Khan  11
Affiliations
Review

The Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors on Cardiovascular Outcomes and All-Cause Mortality in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Tanya Sinha et al. Cureus. .

Abstract

The aim of this systematic review and meta-analysis was to investigate the impact of early sodium-glucose cotransporter-2 (SGLT2) initiation on long-term cardiovascular outcomes and all-cause mortality among patients with acute coronary syndrome (ACS). For this study, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. Two researchers independently performed a comprehensive literature search on PubMed, Embase, and the Cochrane Library, spanning from the inception of each database to February 24, 2023, without language limitations. The outcomes examined in this meta-analysis comprised major adverse cardiovascular events (MACE) (as defined by individual studies), all-cause mortality, cardiovascular mortality, stroke (ischemic and hemorrhagic), recurrent ACS, and hospitalization due to heart failure (HF). A total of nine studies were included in this meta-analysis. The pooled analysis of nine studies revealed a significant reduction in the risk of MACE, all-cause mortality, cardiovascular mortality, and cardiovascular-related hospitalizations among patients receiving SGLT2 inhibitors (SGLT2i) compared to those in the control group. Additionally, there was a trend toward a lower risk of recurrent ACS in the SGLT2i group, although this difference did not reach statistical significance. The findings of this study suggest a promising therapeutic effect of SGLT2 inhibitors in this population. Further research, particularly focusing on myocardial infarction (MI) patients, is warranted to validate these results and potentially revolutionize ACS management.

Keywords: acute coronary syndrome; all-cause mortality; cardiovascular outcomes; sglt2 inhibitor; systematic review and meta-analysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flowchart of study selection
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ACS, acute coronary syndrome
Figure 2
Figure 2. Effect of SGLT2i on MACE
Sources: [12-16,18-20] SGLT2i, sodium-glucose cotransporter-2 inhibitor; MACE, major adverse cardiovascular events; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom
Figure 3
Figure 3. Effect of SGLT2i on all-cause mortality
Sources: [14-18,20] SGLT2i, sodium-glucose cotransporter-2 inhibitors; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom
Figure 4
Figure 4. Effect of SGLT2i on cardiovascular mortality
Sources: [12,13,15,17-19] SGLT2i, sodium-glucose cotransporter-2 inhibitors; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom
Figure 5
Figure 5. Effect of SGLT2i on recurrent ACS
Sources: [15,16,18-20] SGLT2i, sodium-glucose cotransporter-2 inhibitors; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom; ACS, acute coronary syndrome
Figure 6
Figure 6. Effect of SGLT2i on hospitalization due to heart failure
Sources: [12-18] SGLT2i, sodium-glucose cotransporter-2 inhibitors; IV, interval variable; CI, confidence interval; SE, standard error; df, degrees of freedom
See this image and copyright information in PMC

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