Issa, Rochell

This retrospective propensity-matched cohort study assessed the association between sodium-glucose co-transporter-2 inhibitor (SGLT2i) use and cardiovascular outcomes in patients with acute myocardial infarction (AMI) without a history of heart failure. Using the TriNetX U.S. Collaborative Network, we identified 1440 matched patients (720 SGLT2i+ vs 720 SGLT2i−) with preserved ejection fraction and no prior heart failure. Nearly 90% of patients had diabetes. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of MI, stroke, heart failure, and all-cause mortality. At 1 year, MACE occurred in 17.4% of SGLT2i+ versus 22.0% of SGLT2i− patients (odds ratio [OR] 0.746, 95% CI 0.574-0.969; P = .028), and all-cause mortality occurred in 3.1% versus 7.6%, respectively (OR 0.389, 95% CI 0.234-0.645; P < .001). SGLT2i use was also associated with lower risks of major bleeding. Findings were consistent over long-term follow-up. While the observed associations suggest potential cardioprotective effects of SGLT2i post-MI in patients without heart failure, residual confounding cannot be excluded. The observed reduction in bleeding events is novel and warrants further investigation in prospective studies.

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated benefits in heart failure with preserved ejection fraction (HFpEF), but their impact following acute myocardial infarction (AMI) is less well understood. Using the TriNetX Research Network (TriNetX) multi-center registry (2014–2022), we identified patients with heart failure with preserved ejection fraction (HFpEF)—defined as left ventricular ejection fraction (LVEF) >50% and New York Heart Association (NYHA) class II–IV—not previously treated with sodium-glucose co-transporter 2 inhibitors (SGLT2i) who experienced an acute myocardial infarction (AMI). Patients who initiated SGLT2i within 1-year post-AMI were compared with those who did not. Propensity score matching was used to balance cohorts ( n = 20,423 each; mean age 68.3 ± 11.0 years; 54.5% female) for demographics, comorbidities, and treatment variables. The primary outcome was a composite of major adverse cardiovascular events (MACE), including all-cause mortality, recurrent AMI, acute heart failure, and stroke. Secondary outcomes included cardiac arrest and major bleeding. SGLT2i use was associated with lower rates of MACE (3.7% vs 6.1%; P = .0005), all-cause mortality (0.9% vs 5.6%; P < .0001), and other adverse events at both 30 days and 1 year. In this large, propensity-matched cohort, SGLT2i use post-AMI in HFpEF patients was associated with favorable cardiovascular outcomes. Further studies are needed to confirm these associations.