Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Controlled Diabetic Patients Presenting with First Acute Anterior Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background: People with type 2 diabetes (T2DM) face a markedly elevated risk of cardiovascular complications and death. Among contemporary glucose-lowering drugs, sodium–glucose cotransporter-2 inhibitors (SGLT2i) have exhibited broad cardio-renal benefits, lowering rates of heart-failure admission, major adverse cardiovascular events (MACE), as well as kidney injury. Objective: This study explored whether starting an SGLT2i during hospitalization improves clinical and echocardiographic outcomes in T2DM patients experiencing their first acute anterior ST-elevation myocardial infarction (STEMI) managed utilizing primary percutaneous coronary intervention (PPCI). Patients and Methods: Between June and December 2023, 115 consecutive candidates for PPCI who had never used SGLT2i were enrolled. After reperfusion, the treating physician either initiated dapagliflozin 5 mg once daily with the ongoing antidiabetic regimen (Group I) or maintained standard therapy alone (Group II). Ninety-eight participants completed 6-month follow-up. Results: Compared with Group II, Group I exhibited significant 6-month reductions in left-ventricular end-diastolic diameter, end-systolic diameter, end-systolic volume index, and left-atrial volume index. The incidence of MACE was numerically higher in Group II, though not statistically different, and rates of contrast-induced nephropathy were similar. Notably, clinically important arrhythmias occurred less often in Group I. Conclusion: Initiating SGLT2i therapy soon after primary PCI for anterior STEMI in patients with well-controlled T2DM was associated with fewer cardiovascular events involving all-cause mortality, heart-failure hospitalization, as well as MACE and with meaningful improvements in cardiac chamber dimensions and function.