Early use of SGLT2 inhibitors after acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Introduction: Acute myocardial infarction (AMI) continues to be a primary cause of post-hospitalization heart failure (HF), severely impacting morbidity, healthcare resource consumption, and mortality rates.

Objectives: This meta-analysis sought to assess the efficacy and safety of the early introduction of SGLT2 inhibitors in patients hospitalized for AMI, irrespective of previous HF or diabetes history.

Patient and methods: Up until June 10, 2025, a comprehensive search was carried out in six major databases, including randomized controlled trials (RCTs) assessing SGLT2i that were started within 14 days of hospitalization for AMI.

Results: Seven randomized controlled trials (n = 11,405) comparing SGLT2i with placebo or standard medical therapy without SGLT2i, with follow-up ranging from 6 to 18 months, were included. The commencement of SGLT2 inhibitors markedly diminished the likelihood of HF hospitalization (OR = 0.71; 95%CI: 0.58-0.86; P = 0.004). No notable changes were detected in all-cause mortality (OR = 1.05; 95%CI: 0.77-1.43), cardiovascular mortality (OR = 1.04; 95%CI: 0.83-1.30), major adverse cardiovascular events (MACE) (OR = 0.94; 95%CI: 0.85-1.05), recurrent myocardial infarction (OR = 1.12; 95%CI: 0.73-1.72), or stroke (OR = 0.58; 95%CI: 0.26-1.27).

Conclusions: Early initiation of SGLT2i post-AMI significantly reduces the risk of subsequent HF hospitalization without increasing adverse events. However, no mortality benefit was observed. These findings support the selective use of SGLT2i in post-AMI patients at high risk of HF, while highlighting the need for further large-scale trials to assess long-term outcomes and refine patient selection.