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Meta-Analysis
. 2025 Jul 19;25(1):527.
doi: 10.1186/s12872-025-04992-2.

Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis

Davood Semirani-Nezhad  1   2 , Hamidreza Soleimani  3   4 , Morvarid Taebi  2 , Khatere Roozbehi  1   2 , Soodeh Jahangiri  5 , Babak Sattartabar  2 , Fatemeh Takaloo  6 , Bahar Parastooei  2 , Erfan Asfa  7 , Danyal Salabat  8 , Mohammad Mobin Alishahi  9 , Fatemeh Mosayebi  2 , Yaser Jenab  2 , Rahul Gupta  10 , Toshiki Kuno  11 , Wilbert Aronow  12 , Kaveh Hosseini  2
Affiliations
Meta-Analysis

Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis

Davood Semirani-Nezhad et al. BMC Cardiovasc Disord. .

Abstract

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors increase survival rate in heart failure, but early initiation of these agents after acute myocardial infarction (MI) is controversial.

Methods: We searched PubMed, Scopus, Embase, and ClinicalTrial.gov for randomized clinical trials (RCTs) and propensity score matched (PSM) cohort studies up to September 29,2024. Eligible studies of patients with acute MI that were assigned to either SGLT2 inhibitors or placebo were enrolled in final meta-analysis. The primary endpoint was heart failure hospitalization (HHF). Secondary endpoints were: all-cause mortality, stroke, cardiovascular mortality, stroke and composite of major adverse cardiovascular events (MACE).We conducted frequentist and Bayesian meta-analyses.

Results: we identified ten studies (7 RCTs and 3 PSMs) with 15,133 patients. Frequentist meta-analysis showed that SGLT2 inhibitors significantly reduced HHF [RR:0.67 (0.47-0.95); I2: 57%], and MACE significantly decreased in the SGLT2 inhibitor group [RR:0.77 (0.60-0.98); I2: 46%]. Bayesian meta-analysis for HHF suggested a non-significant reduction [RR: 0.8 (95% CrI: 0.4-1.4)]. No significant reduction was observed in SGLT2 inhibitors group regarding all-cause mortality, cardiovascular mortality, non-fatal MI and stroke.

Conclusion: Early initiation of SGLT2 inhibitors in acute MI was associated with reduced risk of HHF, though Bayesian analysis indicates uncertainty. MACE risk significantly reduced and no significant impact was observed on all-cause mortality, CV mortality, non-fatal MI and stroke.

Keywords: Acute coronary syndrome; Heart failure; Myocardial infarction; Sodium-Glucose transporter 2 inhibitors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Since our research involved a systematic review and meta-analysis of already published data, ethical approval was not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: not applicable. Declaration of AI and AI-Assisted technologies in the writing process: In preparing this manuscript, the authors utilized ChatGPT and Grok 3 to enhance grammar and readability. After employing these tools, the authors reviewed and revised the content as necessary, taking full responsibility for the final publication.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Forest plots showing the pooled results of (a) hospitalization for heart failure, (b) all-cause mortality, (c) cardiovascular mortality, (d) major adverse cardiovascular events, (e) non-fatal myocardial infarction, (f) and stroke, using random effect model
Fig. 3
Fig. 3
Subgroup analysis of hospitalization for heart failure in (a) randomized clinical trials, and (b) retrospective studies that used propensity score matching
See this image and copyright information in PMC

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