Early SGLT2 Inhibitor Use After AMI and Lower Mortality in Patients With Diabetes

The early use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes with acute myocardial infarction (AMI) being treated with percutaneous coronary intervention (PCI) is associated with a significantly lower risk of all-cause death and hospitalizations for heart failure (HF), investigators reported in the Journal of the American Heart Association.

The observational study used data from the Korean Health Insurance Review and Assessment Service. Patients with type 2 diabetes aged 18 years or older were identified in the database, and those who received PCI for AMI from January 2014 to August 2018 were enrolled. Patients who received SGLT2 inhibitors for more than 7 consecutive days within 14 days after PCI for AMI were defined as the SGLT2 inhibitor group.

The primary endpoint was a composite of all-cause death and hospitalizations for HF. Secondary analysis of the ischemic endpoint was a composite of all-cause death, nonfatal MI, and nonfatal ischemic stroke.

After 1:2 propensity score matching for the participants with and without SGLT2 inhibitor use, 2814 patients were included (SGLT2 inhibitor group, 938 patients; no-use of SGLT2 inhibitors group, 1876 patients). Their mean age was 57.2 years, 80.0% were men, and the median follow-up was 2.1 years (IQR, 1.4-2.9).

At 2 years, early use of SGLT2 inhibitors was associated with a reduced risk for the primary endpoint compared with no use of SGLT2 inhibitors (9.8% vs 13.9%; adjusted hazard ratio [aHR], 0.68; 95% CI, 0.54-0.87; P =.002).

The SGLT2 inhibitor group had a significantly decreased incidence of all-cause death compared with the no-use of SGLT2 inhibitors group (3.7% vs 6.6%; aHR, 0.55; 95% CI, 0.37-0.80; P =.002). Participants who received SGLT2 inhibitors had a significantly decreased cumulative hospitalization rate for HF (7.4% vs 9.8%; aHR, 0.74; 95% CI, 0.56-0.98; P =.03).

Patients who received SGLT2 inhibitors had a significantly decreased rate of secondary endpoints compared with the no-use of SGLT2 inhibitors group (9.1% vs 11.6%; adjusted HR, 0.77; 95% CI, 0.60-0.99; P =.04), which was mostly attributable to the reduced incidence of all-cause death in the SGLT2 inhibitor group.

In the inverse probability of treatment weighting analysis, the SGLT2 inhibitor group had a decreased risk for the primary endpoint (12.5% vs 19.4%; aHR, 0.62; 95% CI, 0.54-0.78; P <.001).

The overall lower rate of the composite of all-cause death and HF hospitalizations for the SGLT2 inhibitor group were consistent in subgroups based on age, sex, medication, cardiovascular risk factors, and Charlson comorbidity index scores.

Limitations of the study include the retrospective nature and observational design, and prescription rates of SGLT2 inhibitors were low among the participants. Also, the average follow-up was limited, and the propensity-matched population is relatively young. Furthermore, the study does not have adequate data on the causes of death or total mortality.

“Taken together with the proven cardioprotective effects of sodium-glucose cotransporter 2 inhibitors, our results suggest that the use of sodium-glucose cotransporter 2 inhibitors could expand to the acute phase of acute myocardial infarction survivors with diabetes to reduce mortality and the subsequent development of congestive heart failure,” the study authors concluded.