Cardiovascular outcomes of SGLT2 inhibitors across the spectrum of myocardial infarction: A systematic review and meta-analysis
In brief
SGLT2 drugs linked to 26% lower odds of heart failure admission after MI
Across 15 studies and 117,096 people, sodium-glucose cotransporter-2 inhibitors were associated with 26% lower odds of heart failure hospitalization after a heart attack. Overall mortality was also lower, but that finding was driven by observational studies and was not statistically significant in randomized trials; small-study effects and possible publication bias limit confidence in the results.
- Journal
- British journal of clinical pharmacology (Q1)
- Published
- 26 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ahmed Elazab, Ahmed Elbataa, Ahmed Mansour, Mohamed Abouzid, Noha Hammad, Mohammed Sabri Hassanin, et al.
- PMID
- 42928993
- DOI
- 10.1002/bcp.70894
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 27 October 2026): Assesses SGLT2 inhibitors for heart failure after myocardial infarction
Abstract
AIMS: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) help in heart failure (HF), but their benefit after acute myocardial infarction is unclear. This meta-analysis assesses their impact on mortality and heart failure hospitalization post-acute myocardial infarction (AMI) and identifies which patients benefit most. METHODS: Four databases were searched through August 2025 for randomized controlled trials (RCTs) and matched studies comparing SGLT2i with control post-AMI. PRIMARY OUTCOMES: all-cause death and hospitalization for heart failure (HHF); secondary: major adverse cardiovascular events (MACE), cardiovascular (CV) death, stroke and recurrent myocardial infarction (MI). Subgroups and meta-regression examined timing, diabetes, follow-up, design, SGLT2i type and baseline HF/diabetes. RESULTS: Fifteen studies including 117 096 patients (58 613 SGLT2i vs. 58 483 control) were included. A total of 117 096 patients contributed to the all-cause mortality analysis (OR 0.78, 95% CI 0.67-0.90), whereas 116 992 patients across 14 studies contributed to the HHF analysis (OR 0.74, 95% CI 0.63-0.88). All-cause mortality was significantly lower in PSM observational studies (OR 0.64, 95% CI 0.61-0.67), whereas the reduction did not reach statistical significance in RCTs (OR 0.87, 95% CI 0.76-1.01), with a significant interaction by study design. HHF reduction occurred with both early and delayed initiation; dapagliflozin and empagliflozin were similarly effective. MACE was significantly lower with SGLT2i, but CV death, recurrent MI and stroke did not differ. Baseline HF or diabetes showed no association with primary outcomes. CONCLUSIONS: SGLT2i reduced HHF after MI, but this benefit should be interpreted cautiously because of small-study effects and possible publication bias. The all-cause mortality benefit is driven by observational studies; RCTs show a favourable but nonsignificant trend.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.