SGLT2 Inhibitors and Improved Survival in Patients with Diabetes and Acute Myocardial Infarction: Evidence from an Electronic Health Record-Based Cohort Study.

Abstract

Background: Emerging evidence suggests that sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce cardiovascular events in patients with diabetes mellitus (DM) after acute myocardial infarction (AMI), but evidence in Asian populations remains limited.

Objective: We assessed the impact of SGLT2 inhibitors on in-hospital, 30-day, and 30-day to 1-year mortality in a Northern Chinese real-world cohort.

Methods: An electronic health record-based cohort was constructed from the Tianjin Health and Medical Data Platform from January 2013 to December 2022. Statistical analyses, including Kaplan-Meier survival analysis, multivariable regression analysis, and propensity score matching, were undertaken to evaluate the impact of SGLT2 inhibitors on in-hospital, 30-day, and 1-year mortality rates.

Results: A total of 23,486 patients with both AMI and DM were included. Patients treated with SGLT2 inhibitors (n = 5053) were younger (64.2 vs 67.2 years) and had a higher frequency of dyslipidemia (26.4% vs 18.5%) and history of percutaneous coronary intervention (17.1% vs 15.3%) than those who did not receive them. After multivariable adjustment, the use of SGLT2 inhibitors showed a lower mortality rate during hospitalization (odds ratio 0.44; 95% confidence interval [CI] 0.33-0.58), at 30 days (hazard ratio 0.44; 95% CI 0.36-0.53), and at 30 days to 1 year (hazard ratio 0.86; 95% CI 0.73-1.00). These findings were further supported by propensity score matching and subgroup analyses, which consistently confirmed the reduction in mortality across all three time points.

Conclusion: In a real-world electronic health record-based cohort in China, this study confirmed a mortality benefit with the use of SGLT2 inhibitors in patients with combined DM and AMI. Further studies are needed to validate these benefits across broader populations.