Effect of Sodium-Glucose Cotransporter 2 Inhibitors on Cardiovascular Outcomes in Patients with Acute Coronary Syndrome and Type 2 Diabetes.

Objective: To investigate the effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in patients with acute coronary syndrome (ACS) and type 2 diabetes (T2D).

Methods: The clinical data of 88 patients with ACS and T2D who were treated with SGLT2i between January 2020 and December 2021 were collected as the case group through convenience sampling. Patients taking other hypoglycaemic drugs were included as the control group in a 1:1 ratio matched with the case group using retrospective propensity score matching. Relevant data were subsequently collected from both groups for comparison.

Results: Statistically significant differences were observed in glycated haemoglobin (HbA1c) between the two groups (8.11[6.93, 9.41] vs 7.51[6.52, 9.14]%; Z=2.109; P=0.035). The SGLT2i group showed a decrease in major adverse cardiovascular events (MACEs) (P<0.001), secondary composite endpoint events (P=0.024), heart failure readmission (P=0.042) and unplanned revascularisation (P=0.014) compared with the control group. Moreover, the multivariate analysis showed that SGLT2i significantly reduced the risk of MACEs (hazard ratio [HR], 0.472; 95% CI, 0.321-0.694; P<0.001) and unplanned revascularisation (HR, 0.422; 95% CI, 0.212-0.842; P=0.014). In patients with reduced ejection fraction, SGLT2i significantly reduced the risk of MACEs (HR, 0.258; 95% CI, 0.106-0.626; P=0.003) compared with the control group. By contrast, in patients without reduced ejection fraction, SGLT2i significantly reduced the risk of MACEs (HR, 0.640; 95% CI, 0.412-0.996; P=0.048) and unplanned revascularisation (HR, 0.464; 95% CI, 0.222-0.969; P=0.041) compared with the control group.

Conclusion: In addition to significantly reducing the risk of adverse cardiovascular events and unplanned revascularisation in patients with ACS and T2D, the use of SGLT2i can reduce the risk of adverse cardiovascular events regardless of the presence of reduced ejection fraction.