Treatment with SGLT2 inhibitors in the early phase post acute myocardial infarction

There is still no clear and unanimous conclusion regarding the early administration of SGLT2 inhibitors after acute myocardial infarction (AMI). SGLT2 inhibitors (SGLT2I) have proven benefits in reducing mortality and hospitalization rates in heart failure patients with reduced LVEF. The aim of our study was to establish the potential benefits of early post-AMI administration of SGLT2 inhibitors in patients with reduced LVEF, without diabetes.

The study was a prospective one and included patients hospitalized with the diagnosis of acute myocardial infarction, with an LVEF<45% and without symptoms or signs of heart failure. The patients were included in two groups, one that received SGLT2I during hospitalization and the second, control group, without this medication. The basal characteristics were symmetrical in the two groups. The primary objective was the rate of hospitalization for heart failure and cardiovascular mortality.

We included in the study 410 patients, equally divided into two groups. The follow-up was done over a period of 6 months. In the SGLT2I group there were 25 (13%) events (hospitalization for heart failure or death from cardiovascular causes), and in the control group there were 39 (19%) events (odds ratio 0.59, 95% CI, 0, 34-1.02). In the first group there were 23 hospitalizations for heart failure, and in the second 35 (odds ratio 0.61, 95% CI, 0.35-1.08). Death from cardiovascular causes was recorded in 2 patients, in the first group and in 4 patients, in the second (odds ratio 0.52, 95% CI, 0.09-2.86). The rate of occurrence of adverse effects was similar in the two groups.

In patients with high risk of heart failure after acute myocardial infarction, there were no significant differences in the rates of subsequent hospitalization for heart failure and cardiovascular mortality, between the group treated with SGLT2I and the group without this treatment.