Outcomes Associated With SGLT2 Inhibitor Use Following Acute Myocardial Infarction Without Heart Failure: A Propensity-Matched Study

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; <i>P</i> = .028), and all-cause mortality occurred in 3.1% versus 7.6%, respectively (OR 0.389, 95% CI 0.234-0.645; <i>P</i> < .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.