Possibilities of Optimizing Drug Therapy for Myocardial Infarction: a Consensus on the Use of Type 2 Sodium-Glucose Co-Transporter Inhibitors. Conciliation Document of the Expert Group.

Abstract

Ischemic heart disease, including previous myocardial infarction (MI), is one of the main causes for the development and progression of heart failure (HF). The presence of HF before MI or the development of HF in the setting of acute coronary catastrophe is an extremely unfavorable prognostic factor leading to a multiple increase in the risk of death and rehospitalization due to HF in the post-infarction period. In 2024, the results of two randomized clinical trials (RCTs) (DAPA-MI and EMPACT-MI) were published, which assessed the effect of sodium-glucose co-transporter type 2 inhibitors (SGLT2i) on clinical outcomes in patients with acute MI. In both studies, the predetermined primary composite endpoint was not achieved. At the same time, it was shown that SGLT2i significantly reduced the risk of hospitalization for HF (empagliflozin) and contributed to the improvement of metabolic outcomes (dapagliflozin). Also, the safety of early initiation of SGLT2i in the acute period of MI was demonstrated. Based on the available results of randomized and observational clinical studies, the working group has substantiated the need for implementing these RCT results into clinical practice and proposed an algorithm for administering SGLT2 to patients with acute MI. Thus, in the presence of compelling anamnestic criteria for the diagnosis or previously diagnosed type 2 diabetes mellitus, and/or chronic kidney disease, and/or HF, continuation or timely initiation of SGLT2i during the hospitalization for index MI is recommended to improve cardiovascular and renal outcomes. Based on the results of RCTs in patients with acute MI and taking into account individual risk factors for the development of HF, the initiation of SGLT2i before discharge may be considered in order to reduce the risk of hospitalization for HF.