Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis
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 trial...
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BMC
2025-07-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-04992-2 |
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| author | Davood Semirani-Nezhad Hamidreza Soleimani Morvarid Taebi Khatere Roozbehi Soodeh Jahangiri Babak Sattartabar Fatemeh Takaloo Bahar parastooei Erfan Asfa Danyal Salabat Mohammad Mobin Alishahi Fatemeh Mosayebi Yaser jenab Rahul Gupta Toshiki Kuno Wilbert Aronow Kaveh Hosseini |
| author_facet | Davood Semirani-Nezhad Hamidreza Soleimani Morvarid Taebi Khatere Roozbehi Soodeh Jahangiri Babak Sattartabar Fatemeh Takaloo Bahar parastooei Erfan Asfa Danyal Salabat Mohammad Mobin Alishahi Fatemeh Mosayebi Yaser jenab Rahul Gupta Toshiki Kuno Wilbert Aronow Kaveh Hosseini |
| author_sort | Davood Semirani-Nezhad |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-3a45345086944ff8ad40e2a21682a66e |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-3a45345086944ff8ad40e2a21682a66e2025-08-20T04:01:46ZengBMCBMC Cardiovascular Disorders1471-22612025-07-0125111010.1186/s12872-025-04992-2Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysisDavood Semirani-Nezhad0Hamidreza Soleimani1Morvarid Taebi2Khatere Roozbehi3Soodeh Jahangiri4Babak Sattartabar5Fatemeh Takaloo6Bahar parastooei7Erfan Asfa8Danyal Salabat9Mohammad Mobin Alishahi10Fatemeh Mosayebi11Yaser jenab12Rahul Gupta13Toshiki Kuno14Wilbert Aronow15Kaveh Hosseini16School of Medicine, Yasuj University of Medical SciencesCardiovascular Diseases Research Institute, Tehran University of Medical SciencesCardiovascular Diseases Research Institute, Tehran University of Medical SciencesSchool of Medicine, Yasuj University of Medical SciencesEndocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical SciencesCardiovascular Diseases Research Institute, Tehran University of Medical SciencesSchool of Medicine, Tehran University of Medical SciencesCardiovascular Diseases Research Institute, Tehran University of Medical SciencesSchool of Medicine, Shahid Beheshti University of Medical SciencesStudent Research Committee, Arak University of Medical SciencesIslamic Azad University, Tehran Medical BranchCardiovascular Diseases Research Institute, Tehran University of Medical SciencesCardiovascular Diseases Research Institute, Tehran University of Medical SciencesYale University School of MedicineCardiology Division, Massachusetts General Hospital, Harvard Medical SchoolDepartment of Cardiology, New York Medical College and Westchester Medical CenterCardiovascular Diseases Research Institute, Tehran University of Medical SciencesAbstract 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.https://doi.org/10.1186/s12872-025-04992-2Sodium-Glucose transporter 2 inhibitorsMyocardial infarctionAcute coronary syndromeHeart failure |
| spellingShingle | Davood Semirani-Nezhad Hamidreza Soleimani Morvarid Taebi Khatere Roozbehi Soodeh Jahangiri Babak Sattartabar Fatemeh Takaloo Bahar parastooei Erfan Asfa Danyal Salabat Mohammad Mobin Alishahi Fatemeh Mosayebi Yaser jenab Rahul Gupta Toshiki Kuno Wilbert Aronow Kaveh Hosseini Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis BMC Cardiovascular Disorders Sodium-Glucose transporter 2 inhibitors Myocardial infarction Acute coronary syndrome Heart failure |
| title | Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis |
| title_full | Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis |
| title_fullStr | Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis |
| title_full_unstemmed | Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis |
| title_short | Early initiation of SGLT2 inhibitors in acute myocardial infarction and cardiovascular outcomes, an updated systematic review and meta-analysis |
| title_sort | early initiation of sglt2 inhibitors in acute myocardial infarction and cardiovascular outcomes an updated systematic review and meta analysis |
| topic | Sodium-Glucose transporter 2 inhibitors Myocardial infarction Acute coronary syndrome Heart failure |
| url | https://doi.org/10.1186/s12872-025-04992-2 |
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