{"id":104762,"date":"2025-02-07T15:55:13","date_gmt":"2025-02-07T15:55:13","guid":{"rendered":"https:\/\/touchendocrinology.com\/?p=104762"},"modified":"2025-02-07T17:05:41","modified_gmt":"2025-02-07T17:05:41","slug":"efficacy-and-safety-of-early-initiation-of-sodium-glucose-co-transporter-2-inhibitors-following-acute-myocardial-infarction-a-systematic-review-and-meta-analysis","status":"publish","type":"post","link":"https:\/\/touchendocrinology.com\/diabetes\/journal-articles\/efficacy-and-safety-of-early-initiation-of-sodium-glucose-co-transporter-2-inhibitors-following-acute-myocardial-infarction-a-systematic-review-and-meta-analysis\/","title":{"rendered":"Efficacy and Safety of Early Initiation of Sodium\u2013Glucose Co-transporter-2 Inhibitors Following Acute Myocardial Infarction: A Systematic Review and Meta-analysis"},"content":{"rendered":"
Early use of sodium\u2013<\/span>glucose co-transporter-2 inhibitors following myocardial infarction was associated with the following factors:<\/span><\/p>\n <\/span>Lower hospitalization for heart failure (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.62\u20130.90; p=0.002).<\/span><\/p>\n<\/li>\n Similar cardiovascular deaths (OR: 1.04; 95% CI: 0.83\u20131.30; p=0.76).<\/span><\/p>\n<\/li>\n Similar all-cause mortality (OR: 1.00; 95% CI: 0.82\u20131.21; p=0.98).<\/span><\/p>\n<\/li>\n Similar risks of ketoacidosis, acute renal failure or hepatic injury.<\/span><\/p>\n<\/li>\n<\/ul>\n <\/p>\n Early and timely percutaneous coronary intervention (PCI) therapies, effective anti-platelet therapy along with aggressive early lipid lowering with high-intensity statins and other lipid mediations are the current cornerstones for improving short- and long-term outcomes in patients with acute myocardial infarction (AMI).1<\/sup><\/span>\u00a0However, despite these advances, a significant amount of residual cardiovascular (CV) risk remains in these patients for a recurrent CV event, especially in the initial few weeks of the index event. Sodium\u2013<\/span>glucose co-transporter-2 inhibitors (SGLT2i) are considered to be the preferred agents for managing type 2 diabetes (T2D) in patients with established atherosclerotic cardiovascular disease (ASCVD) and those with multiple risk factors for ASCVD.2,3<\/sup><\/span>\u00a0In addition, SGLT2i have established themselves as the preferred agents for reducing hospitalization for heart failure (HHF) in patients with heart failure with reduced and preserved ejection fraction, regardless of their underlying glycaemic status.2\u20134<\/sup><\/span>\u00a0SGLT2i have demonstrated themselves to improve a broad range of CV outcomes, especially CV death and HHF in different randomized controlled trials (RCTs) and meta-analyses.3\u20135<\/sup><\/span><\/p>\n Recently, several RCTs have been published evaluating the role of SGLT2i in myocardial infarction (MI).6\u20139<\/sup><\/span>\u00a0Traditionally, the use of SGLT2i, in general, has been avoided during acute illness (infections, surgery or acute events such as AMI) due to safety concerns primarily related to the increased risk of euglycaemic ketosis.10<\/sup><\/span>\u00a0In addition, the effectiveness of a medicine in improving CV and mortality outcomes in patients with stable ASCVD and chronic heart failure does not guarantee its efficacy in AMI. A prime example is sacubitril-valsartan, which reduces CV deaths and HHF in patients with chronic heart failure with reduced ejection fraction but not when used in the setting of AMI (Prospective ARNI versus ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events after MI [PARADISE-MI trial];\u00a0ClinicalTrials.gov identifier:<\/span>\u00a0NCT02924727).11,12<\/sup><\/span>\u00a0This makes it even more important to study SGLT2i in AMI, despite their proven efficacy in chronic heart failure. A literature review revealed that no meta-analysis is available that has holistically analysed and summarized the clinical efficacy and safety of SGLT2i following MI. Hence, the aim of this systematic review and meta-analysis (SRM) was to evaluate the efficacy and safety of SGLT2i in MI.<\/p>\n This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists and the procedures described in the Cochrane Handbook for Systematic Reviews of Interventions.13,14<\/sup><\/span>\u00a0The SRM was registered with PROSPERO (CRD42024533973), and the protocol summary is accessible online. All RCTs published till March 2024 were considered for this meta-analysis. As ethical approval already exists for the individual studies included in the meta-analysis, no separate approval was required for this study.<\/p>\n Population, Intervention, Comparison, Outcomes and Study design was used as a framework to formulate eligibility criteria for the clinical trials in this SRM. The patient population (P) consisted of patients with MI; the intervention (I) was the use of SGLT2i along with the standard therapy for managing MI; the comparison or control (C) involved patients either on placebo or any other medication over the background standard therapy for MI; the outcomes (O) evaluated included all-cause death\/mortality, CV death, HHF, stroke, recurrence of MI, changes in N-terminal pro-b-type natriuretic peptide (NT-proBNP), weight, echocardiography parameters and any adverse effects noted; and RCTs were considered as the study type (S) for inclusion. This study comprised RCTs with study individuals aged at least 18 years. Only those RCTs were considered for this meta-analysis where SGLT2i was initiated within 2 weeks of the index MI event.<\/p>\n The primary outcome was to evaluate the changes in CV death, all-cause death\/mortality and HHF. The secondary outcomes of this study were to evaluate the alterations in echocardiographic parameters (left ventricular ejection fraction [LVEF]), NT-proBNP, high-sensitivity C-reactive protein (hs-CRP), occurrence of stroke, recurrence of MI, all-cause hospitalization and safety issues such as changes in weight, occurrence of ketoacidosis, acute renal failure and hepatic injury. Sub-group analysis was performed based on whether the control group received an active comparator (active control group) or a placebo (passive control group).<\/p>\n Several databases and registers, including MEDLINE (via PubMed), Scopus, Cochrane Central Register and ClinicalTrials.gov, were systematically searched. The search covered these sources from their commencement to 30 March 2024. The search terms were applied to titles only; the search technique followed a Boolean approach using the terms \u2018SGLT2\u2019 OR \u2018sodium glucose co-transporter-2 inhibitor\u2019 OR \u2018dapagliflozin\u2019 OR \u2018empagliflozin\u2019 OR \u2018canagliflozin\u2019 OR \u2018ertugliflozin\u2019 OR \u2018sotagliflozin\u2019 AND \u2018myocardial infarction\u2019.<\/p>\n Every recently published or unpublished clinical study in English was searched exhaustively and carefully. This search involved looking through pertinent publications and references found in the clinical trials included in the present work.<\/p>\n Four review authors independently conducted data extraction using standardized data extraction forms, with details provided elsewhere.15,16<\/sup><\/span>\u00a0The handling of missing data has also been elaborated upon in the same source.15,16<\/sup><\/span>\u00a0RevMan Web 2024 version was used for comparing the mean difference (MD) of the different primary and secondary outcomes between the SGLT2i and the control groups of the included studies. Random effects analysis models were chosen to address the anticipated heterogeneity due to variations in population characteristics and trial lengths. The inverse variance statistical method was applied for all instances. The meta-analysis encompassed forest plots that integrated data from a minimum of two trials. A significance level of\u00a0p<\/span><\/span><\/span><\/em><0.05 was used.<\/p>\n Three authors independently assessed the risk of bias (ROB) using the ROB assessment tool in Review Manager (RevM<\/span>an) Web Version 2024 (The Cochrane Collaboration, Oxford, UK, 2024) software. ROB assessment was performed under the following headings: adequate sequence generation (selection bias); adequate allocation concealment (selection bias); adequate prevention of knowledge of allocated interventions during the study; blinding of participants and personnel (performance bias); blinding of outcome assessors (detection bias); incomplete outcome data (attrition bias); and freedom from selective outcome reporting (reporting bias). Involvement of pharmaceutical organizations in the funding, conducting the study and preparing the draft was considered to be high ROB under other bias sub-headings.<\/p>\n The assessment of heterogeneity was initially conducted by studying forest plots. Subsequently, a\u00a0\u03c7<\/em><\/span>2<\/sup>\u00a0test was performed using N-1 degrees of freedom and a significance level of 0.05 to determine the statistical significance. The\u00a0I<\/em>2<\/sup>\u00a0test was also used in the subsequent analysis.14<\/sup><\/span>\u00a0The specifics of understanding\u00a0I<\/em>2<\/sup>\u00a0values have already been explained in depth elsewhere.15,16<\/sup><\/span><\/p>\n The Grading of Recommendations Assessment, Development and Evaluation methodology was used to determine the quality of evidence about each meta-analysis outcome.17,18<\/sup><\/span>\u00a0The details of generating the summary of findings (SoF) table and judging the quality of evidence as \u2018high\u2019, \u2018moderate\u2019, \u2018low\u2019 or \u2018very low\u2019 have been previously reported.15,16<\/sup><\/span><\/p>\n This SRM was done as per the preregistered protocol with PROSPERO without any deviation (CRD42024533973). A total of 8,922 articles were found after the initial search (Figure 1<\/span><\/em>). Four hundred and eighty duplicates were removed following the screening of the titles, and the search was reduced to 106 articles. After further review of these 106 abstracts, the search was reduced to 12 studies, which were then evaluated in detail for inclusion in this meta-analysis (Supplementary Material 1<\/em><\/span>). Eight articles presenting data from six different RCTs (7,409 patients) that fulfilled all criteria were analysed in this meta-analysis.6\u20139,19\u201322<\/sup><\/span><\/p>\n (a<\/span>)\u00a0<\/span>Cardiovascular death; (b<\/span>)\u00a0<\/span>a<\/span>ll-cause death\/mortality; (c<\/span>)\u00a0<\/span>ho<\/span>spitalization for heart failure; (d<\/span>)\u00a0<\/span>LVEF; (e<\/span>)\u00a0<\/span>NT-proBNP and (f<\/span>)\u00a0<\/span>per<\/span><\/span>centage change in NT-proBNP from baseline.<\/em><\/p>\n CI = confidence interval; df = degrees of freedom; IV = inverse variance; LVEF = left ventricular ejection fraction; NT-proBNP = N-terminal pro-b-type natriuretic peptide; SD = standard deviation;\u00a0SGLT2i<\/span>\u00a0= sodium\u2013<\/span>glucose co-transporter-2 inhibitors.<\/em><\/p>\n<\/div>\n The study by James\u00a0et al<\/span>. was a double-blinded RCT comparing 1-year outcomes of dapagliflozin 10 mg\/day with placebo initiated in patients with AMI within 10 days of the index event (Dapaglifozin Effects on Cradiometabolic Outcomes in Patients with an Acute Heart Attack [DAPA-MI]<\/span>; ClinicalTrials.gov identifier: NCT04564742).6<\/sup><\/span>\u00a0The study by Butler\u00a0et al<\/span>. was a double-blinded RCT comparing outcomes in patients receiving empagliflozin 10 mg\/day with placebo when initiated with 14 days of AMI, having a mean follow-up of around 18 months (Empagliflozin after Acute Myocardial Infarction [EMPACT-MI]: A Study to Test Whether Empagliflozin Can Lower the Risk of Heart Failure and Death in People Who Had a Heart Attack [Myocardial Infarction]<\/span>; ClinicalTrials.gov identifier: NCT04509674).7<\/sup><\/span>\u00a0The study by Dayem\u00a0et al<\/span>.<\/em>\u00a0was a double-blinded RCT comparing 12-week outcomes of the impact on NT-proBNP and echocardiography parameters after the initiation of dapagliflozin 10 mg\/day with placebo in patients with AMI (Impact of Dapagliflozin on Cardiac Function Following Anterior Myocardial Infarction in Non-diabetic Patients [DACAMI trial];\u00a0ClinicalTrials.gov identifier: <\/span>NCT05424315).8<\/sup><\/span>\u00a0In the DACAMI trial, dapagliflozin was started within 72\u00a0<\/span>h of\u00a0ST elevation myocardial infarction<\/span>.8<\/sup><\/span>\u00a0The study by von Lewinski\u00a0et al<\/span>.<\/em>\u00a0was a double-blinded RCT evaluating 26-week outcomes of the impact on NT-proBNP and echocardiographic parameters after the initiation of empagliflozin 10 mg\/day with placebo, initiated within 72\u00a0<\/span>h of PCI in patients with AMI (Empagliflozin in Acute Myocardial Infarction [EMMY trial];\u00a0ClinicalTrials.gov identifier: <\/span>NCT03087773).9<\/sup><\/span>\u00a0Benedikt\u00a0et al<\/span>. studied changes in inflammatory markers with empagliflozin therapy in the same cohort of patients with MI from the EMMY trial.19<\/sup><\/span>\u00a0Therefore, the results from this article have been analysed under von Lewinski\u00a0et al<\/span>.<\/em>\u00a0in this SRM. Sourij\u00a0et al<\/span>.<\/em>\u00a0analysed the gender differences in response to empagliflozin therapy after AMI in the cohort of patients of the EMMY trial.20<\/sup><\/span>\u00a0<\/span><\/em>The study by Mozawa\u00a0et al<\/span>.<\/em>\u00a0was a double-blinded RCT evaluating the impact of empagliflozin 10 mg\/day compared with placebo initiated within 2 weeks of AMI in Japanese patients (Effects of Empagliflozin versus Placebo on Cardiac Sympathetic Activity in Acute Myocardial Infarction Patients with Type 2 Diabetes Mellitus [EMBODY trial]: UMIN000030158]).21<\/sup><\/span>\u00a0The article by Hoshika\u00a0et al<\/span>.<\/em>\u00a0was from the same cohort of patients in the EMBODY trial.22<\/sup><\/span>\u00a0Therefore, the results from this study have been presented under Mozawa\u00a0et al<\/span>.<\/em>\u00a0in this SRM. The study by Adel\u00a0et al<\/span>.<\/em>\u00a0evaluated the impact of empagliflozin 10 mg\/day compared with placebo in improving CV outcomes in patients with diabetes with acute coronary syndrome (ACS) after PCI.23<\/sup><\/span>\u00a0The details of the studies included in this SRM have been elaborated in\u00a0Table 1<\/span><\/em>.6\u20139,19,20<\/sup><\/span><\/p>\n Parameter<\/p>\n<\/td>\n Adel 202220<\/sup><\/span><\/p>\n<\/td>\n Butler 2024 (EMPACT-MI\u00a0trial<\/span>)7<\/sup><\/span><\/p>\n<\/td>\n Dayem 2023<\/span>\u00a0(DACAMI\u00a0trial<\/span>)8<\/sup><\/span><\/p>\n<\/td>\n James 2024<\/span>\u00a0(DAPA-MI\u00a0trial<\/span>)6<\/sup><\/span><\/p>\n<\/td>\n Mozawa 2021<\/span>\u00a0(EMBODY\u00a0trial<\/span>)19<\/sup><\/span><\/p>\n<\/td>\n von Lewinski 2022<\/span>\u00a0(EMMY\u00a0trial<\/span>)9<\/sup><\/span><\/p>\n<\/td>\n<\/tr>\n Empagliflozin (n=45)<\/p>\n<\/td>\n Control\/placebo (n=48)<\/p>\n<\/td>\n Empagliflozin (n=3,260)<\/p>\n<\/td>\n Control\/placebo (n=3,262)<\/p>\n<\/td>\n Dapagliflozin (n=50)<\/p>\n<\/td>\n Control (n=50)<\/p>\n<\/td>\n Dapagliflozin (n=2,019)<\/p>\n<\/td>\n Control\/placebo (n=1,998)<\/p>\n<\/td>\n Empagliflozin (n=46)<\/p>\n<\/td>\n Control\/placebo (n=50)<\/p>\n<\/td>\n Empagliflozin (n=237)<\/p>\n<\/td>\n Control\/placebo (n =239)<\/p>\n<\/td>\n<\/tr>\n<\/thead>\n Age (years)<\/p>\n<\/td>\n 55 (45.5\u201364)<\/p>\n<\/td>\n 57 (50\u201366.75)<\/p>\n<\/td>\n 63.6 \u00b1 11.0<\/p>\n<\/td>\n 63.7 \u00b1 10.8<\/p>\n<\/td>\n 55.24 \u00b1 13.2<\/p>\n<\/td>\n 56.70 \u00b1 11.5<\/p>\n<\/td>\n 63.0 \u00b1 11.06<\/p>\n<\/td>\n 62.8 \u00b1 10.64<\/p>\n<\/td>\n 63.9 (10.4)<\/p>\n<\/td>\n 64.6 \u00b1 11.6<\/p>\n<\/td>\n 57 (52\u201364)<\/p>\n<\/td>\n 57 (52\u201365)<\/p>\n<\/td>\n<\/tr>\n Male sex (%)<\/p>\n<\/td>\n 60.0<\/p>\n<\/td>\n 60.4<\/p>\n<\/td>\n 75.1<\/p>\n<\/td>\n 75.1<\/p>\n<\/td>\n 84<\/p>\n<\/td>\n 82<\/p>\n<\/td>\n 80.8<\/p>\n<\/td>\n 79.0<\/p>\n<\/td>\n 82.6<\/p>\n<\/td>\n 78<\/p>\n<\/td>\n 82<\/p>\n<\/td>\n 82<\/p>\n<\/td>\n<\/tr>\n Weight (kg)<\/p>\n<\/td>\n 75 (67.5\u201384.5)<\/p>\n<\/td>\n 69.5 (65\u201383.75)<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 85.5 \u00b1 15.87<\/p>\n<\/td>\n 85.5 \u00b1 16.54<\/p>\n<\/td>\n 70.1 \u00b1 13.7<\/p>\n<\/td>\n 68.1 \u00b1 14.4<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n<\/tr>\n BMI (kg\/m2<\/sup>)<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 28.1 \u00b1 5<\/p>\n<\/td>\n 28.1 \u00b1 5<\/p>\n<\/td>\n 29.96 \u00b1 4.9<\/p>\n<\/td>\n 30.13 \u00b1 4.6<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 25.2 \u00b1 3.7<\/p>\n<\/td>\n 25.2 \u00b1 4.1<\/p>\n<\/td>\n 27.7 (25.3\u201330.3)<\/p>\n<\/td>\n 27.2 (24.9\u201330.2)<\/p>\n<\/td>\n<\/tr>\n SBP (mm Hg)<\/p>\n<\/td>\n 130 (116.25\u2013150)<\/p>\n<\/td>\n 130 (116.25\u2013140)<\/p>\n<\/td>\n 120.3 (14.6)<\/p>\n<\/td>\n 120.5 (15.2)<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 119.1 \u00b1 16.23<\/p>\n<\/td>\n 118.7 \u00b1 16.62<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 125 (116\u2013131)<\/p>\n<\/td>\n 125 (118\u2013131)<\/p>\n<\/td>\n<\/tr>\n eGFR<\/p>\n (mL\/min\/1.73 m2<\/sup>)<\/p>\n<\/td>\n 72 (61\u201383)<\/p>\n<\/td>\n 76 (61.25\u201381)<\/p>\n<\/td>\n 77.5 (62.2\u201391.0)<\/p>\n<\/td>\n 78.0 (61.7\u201391.4)<\/p>\n<\/td>\n 82.61 \u00b1 14.31<\/p>\n<\/td>\n 85.49 \u00b1 13.49<\/p>\n<\/td>\n 83.5 \u00b1 17.12<\/p>\n<\/td>\n 83.4 \u00b1 16.91<\/p>\n<\/td>\n 64.60 \u00b1 14.95<\/p>\n<\/td>\n 66.14 \u00b1 15.72<\/p>\n<\/td>\n 92 (78\u2013101)<\/p>\n<\/td>\n 91 (78\u2013102)<\/p>\n<\/td>\n<\/tr>\n HbA1c (%)<\/p>\n<\/td>\n 7.8 (7.2\u20138.45)<\/p>\n<\/td>\n 7.8 (7.1\u20138.05)<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 5.7 \u00b1 0.58<\/p>\n<\/td>\n 5.7 \u00b1 0.51<\/p>\n<\/td>\n 6.82 \u00b1 1.00<\/p>\n<\/td>\n 6.89 \u00b1 0.92<\/p>\n<\/td>\n 5.60 (5.40\u20136.00)<\/p>\n<\/td>\n 5.70 (5.40\u20136.00)<\/p>\n<\/td>\n<\/tr>\n Index MI (%)<\/p>\n<\/td>\n STEMI<\/p>\n<\/td>\n 60<\/p>\n<\/td>\n 50<\/p>\n<\/td>\n 75<\/p>\n<\/td>\n 73.6<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 72.6<\/p>\n<\/td>\n 71.5<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n<\/tr>\n NSTEMI<\/p>\n<\/td>\n 4.4<\/p>\n<\/td>\n 8.3<\/p>\n<\/td>\n 25<\/p>\n<\/td>\n 26.4<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 27.4<\/p>\n<\/td>\n 28.5<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n<\/tr>\n Previous cardiovascular history (%)<\/p>\n<\/td>\n MI<\/p>\n<\/td>\n \n<\/td>\n \n<\/td>\n 11.9<\/p>\n<\/td>\n 14.1<\/p>\n<\/td>\n 12<\/p>\n<\/td>\n 14<\/p>\n<\/td>\n 8.8<\/p>\n<\/td>\n 9.5<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 5.9<\/p>\n<\/td>\n 3.8<\/p>\n<\/td>\n<\/tr>\n Stroke<\/p>\n<\/td>\n 2.2<\/p>\n<\/td>\n 4.2<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n 2.3<\/p>\n<\/td>\n 2.5<\/p>\n<\/td>\n 15.2<\/p>\n<\/td>\n 22<\/p>\n<\/td>\n 2.1<\/p>\n<\/td>\n 0.4<\/p>\n<\/td>\n<\/tr>\n AF<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 11.0<\/p>\n<\/td>\n 11.1<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \n<\/td>\n \n<\/td>\n<\/tr>\n T2D<\/p>\n<\/td>\n 100<\/p>\n<\/td>\n 100<\/p>\n<\/td>\n 31.7<\/p>\n<\/td>\n 32.1<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n 100<\/p>\n<\/td>\n 100<\/p>\n<\/td>\n 13<\/p>\n<\/td>\n 14<\/p>\n<\/td>\n<\/tr>\n HT<\/p>\n<\/td>\n 57.8<\/p>\n<\/td>\n 66.7<\/p>\n<\/td>\n 69.4<\/p>\n<\/td>\n 69.8<\/p>\n<\/td>\n 64<\/p>\n<\/td>\n 58<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 82.6<\/p>\n<\/td>\n 78.0<\/p>\n<\/td>\n 39<\/p>\n<\/td>\n 45<\/p>\n<\/td>\n<\/tr>\n PAD<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 5.3<\/p>\n<\/td>\n 5.5<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n<\/tr>\n Unstable angina (%)<\/p>\n<\/td>\n 35.6<\/p>\n<\/td>\n 43.8<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n 0<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n<\/tr>\n Patient characteristics<\/p>\n<\/td>\n Inclusion criteria: adults over 18 years with a prior diagnosis of T2D and ACS, including ST elevation MI, non-ST elevation MI or unstable angina. Exclusion criteria: DKA, urinary and genital infections, T1D, severe liver failure, malignancy, eGFR <30 mL\/min\/1.73 m2<\/sup>\u00a0and non-adherence<\/p>\n<\/td>\n Inclusion criteria: adults over 18 years hospitalized with acute MI within 14 days before randomization, presenting evidence of either a newly developed LVEF <45% or signs\/symptoms of congestion necessitating treatment. Exclusion criteria: previous heart failure diagnosis and use of SGLT2i<\/p>\n<\/td>\n Inclusion criteria: patients with anterior STEMI, LVEF <50% and successful pPCI. Exclusion criteria: patients with diabetes, prior HF, cardiotoxic medication, haemoglobinopathies, chronic organ damage, existing SGLT2i use, need for additional anticoagulation or contraindications for dapagliflozin<\/p>\n<\/td>\n Inclusion criteria: stable adults over 18 years hospitalized for acute MI and with LV systolic dysfunction or Q-wave MI on ECG. Exclusion criteria: established diabetes, symptomatic HF with reduced LVEF \u226440% and current SGLT2i treatment<\/p>\n<\/td>\n Inclusion criteria: adults over 20 years with diagnosed T2D according to Japanese guidelines and patients within 2\u201312 weeks after the onset of acute MI. Exclusion criteria: T1D, persistent AF, use of insulin, GLP1RA or high-dose sulfonylurea, HbA1C >10%, recent DKA or coma, renal dysfunction (eGFR <45 mL\/min\/1.73 m2<\/sup>), NYHA functional class IV heart failure, pregnancy or breastfeeding and contraindications to empagliflozin<\/p>\n<\/td>\n Inclusion criteria: patients aged 18\u201380 years with confirmed acute large MI (CK >800 IU\/L), high troponin T (or I) >10\u00d7 upper limit, and eGFR >45 mL\/min\/1.73 m2<\/sup>. Exclusion criteria: patients with non T2D, pH <7.32, haemodynamic instability, acute UTI or genital infection, current or recent SGLT2i treatment<\/p>\n<\/td>\n<\/tr>\n Duration of study<\/p>\n (weeks)<\/p>\n<\/td>\n 24<\/p>\n<\/td>\n 24<\/p>\n<\/td>\n 12<\/p>\n<\/td>\n 48<\/p>\n<\/td>\n 24<\/p>\n<\/td>\n 26<\/p>\n<\/td>\n<\/tr>\n Key outcomes<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n There was no difference in the incidence of hypoglycaemia or lower limb amputations<\/p>\n<\/td>\n None of the patients in the study group receiving dapagliflozin encountered genitourinary infections or hypoglycaemic episodes<\/p>\n<\/td>\n There was no increase in serious adverse events related to adverse<\/p>\n reactions that could potentially be associated with SGLT2i, such as hypovolaemia, hypotension, amputations or genital infections<\/p>\n<\/td>\n \u2013<\/p>\n<\/td>\n Incidence of genital infections and showed no significant difference between the empagliflozin and placebo. No amputations or severe hypoglycaemic episodes were reported. While beta-hydroxybutyrate concentrations increased significantly more in the empagliflozin group compared with placebo, there was no difference in the occurrence of DKA<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n All continuous variables have been expressed either as mean \u00b1 standard deviation or median (interquartile range).<\/em><\/p>\n<\/div>\n ACS<\/span>\u00a0=\u00a0acute coronary syndrome<\/span>; <\/span>AF<\/span>\u00a0=\u00a0atrial fibrillation<\/span>; <\/span>BMI<\/span>\u00a0=\u00a0body mass index<\/span>; <\/span>CK<\/span>\u00a0=\u00a0creatine kinase<\/span>; <\/span>DKA<\/span>\u00a0=\u00a0diabetic ketoacidosis<\/span>; <\/span>ECG<\/span>\u00a0=\u00a0electrocardiogram<\/span>; <\/span>eGFR<\/span>\u00a0=\u00a0estimated glomerular filtration rate<\/span>; <\/span>GLP1RA<\/span>\u00a0=\u00a0glucagon-like peptide-1 receptor agonist<\/span>; <\/span>HbA1C<\/span>\u00a0=\u00a0haemoglobin A1C<\/span>; <\/span>HF<\/span>\u00a0=\u00a0heart failure<\/span>; <\/span>\n
\nMethods<\/h1>\n
Methodology<\/h2>\n
Search method for identifying studies<\/h2>\n
Data extraction, study selection, measurement of treatment effects and data synthesis<\/h2>\n
Assessment of risk of bias in the included studies<\/h2>\n
Assessment of heterogeneity<\/h2>\n
Grading of the results<\/h2>\n
Results<\/h1>\n
Figure 1: <\/span>Forest plot highlighting the impact of early initiation of sodium\u2013<\/span>glucose co-transporter-2 inhibitors in patients with myocardial infarction<\/h2>\n
<\/p>\n
Table 1: <\/span>Baseline characteristics of patients in the randomized controlled trials analysed in this systematic review and meta-analysis6\u20139,19,20<\/sup><\/span><\/h2>\n
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