Title : Effect of sodium glucose co-transporter 2 inhibitors (SGLT2i) on ejection fraction in acute myocardial infarction: A systematic review and meta-analysis
Abstract:
Background:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are principally known as agents for the control of Type 2 diabetes mellitus (Type 2 DM). In recent years, they have gained more attention, especially for their role in cardiovascular protection in Type 2 diabetes patients, in non-diabetic patients with heart failure, and in reducing rehospitalization rates and mortality rates in heart failure patients. This study assessed the effect on change in LV ejection fraction from baseline after adding sodium-glucose cotransporter 2 (SGLT2) inhibitors on top of standard therapy to the current regimen for acute myocardial infarction (AMI).
Methods:
This was a systematic review and meta-analysis of 5 randomized controlled trials (RCTs) that were selected from Pubmed, Google Scholar, Cochrane, and Herdin using the inclusion and exclusion criteria set in this study. Jadad score and funnel plot was used to assess for the risk of bias in the included studies. Analysis was performed using Cochrane Review Manager (Revman) 5, wherein the mean difference were computed using inverse variance approach and random effects mode were computed at 95% confidence interval. Forest plot was also generated to display the significance of the intervention of each study.
Results:
There was a total of 807 patients included in this meta-analysis, with majority being predominantly male, with an age range of 45 to 74 years old, with a heterogenous distribution of comorbidities (Type 2 DM, previous history of stroke, and smoking history). The results showed statistically significant improvement in the ejection fraction in the SGLT2i group after the follow up period (range of 12 weeks to 28 weeks) by 1.61% compared to the placebo group (95% CI 0.50, 2.73, p < 0.01). On subgroup analysis, post-PCI patients had more statistically significant and consistent results compared to the non-PCI patients, with a mean difference of 1.67% (95% CI 0.72, 2.63, p < 0.001).
Audience take away:
- The potential role of SGLT2 inhibitors in the setting of acute coronary syndrome
- The specific settings where the use of SGLT2 inhibitors in acute coronary syndrome can confer the greatest improvement in lab parameters
- Potential further topics of interest for future clinical trials on SGLT2 inhibitors
