Effect of Sodium–Glucose Cotransporter 2 Inhibitors on Cardiovascular Outcomes in Patients with Acute Coronary Syndrome and Type 2 Diabetes

Han Xie,1,2 Ming-Jian Jiang3 1Department of Cardiovascular Medicine, The Central Hospital of Wuhan, Wuhan, People’s Republic of China; 2Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People’s Republic of China; 3Department of Cardiovascular Medicine, Huangshi Aikang Hospital in Hubei Province, Wuhan, People’s Republic of ChinaCorrespondence: Ming-Jian Jiang, Department of Cardiovascular Medicine, Huangshi Aikang Hospital in Hubei Province, No. 563 of Yiyang Road,Xisaishan District, Huangshi, 430051, People’s Republic of China, Tel +86-13677149029, Email [email protected]: To investigate the effect of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in patients with acute coronary syndrome (ACS) and type 2 diabetes (T2D).Methods: The clinical data of 88 patients with ACS and T2D who were treated with SGLT2i between January 2020 and December 2021 were collected as the case group through convenience sampling. Patients taking other hypoglycaemic drugs were included as the control group in a 1:1 ratio matched with the case group using retrospective propensity score matching. Relevant data were subsequently collected from both groups for comparison.Results: Statistically significant differences were observed in glycated haemoglobin (HbA1c) between the two groups (8.11[6.93, 9.41] vs 7.51[6.52, 9.14]%; Z=2.109; P=0.035). The SGLT2i group showed a decrease in major adverse cardiovascular events (MACEs) (P< 0.001), secondary composite endpoint events (P=0.024), heart failure readmission (P=0.042) and unplanned revascularisation (P=0.014) compared with the control group. Moreover, the multivariate analysis showed that SGLT2i significantly reduced the risk of MACEs (hazard ratio [HR], 0.472; 95% CI, 0.321– 0.694; P< 0.001) and unplanned revascularisation (HR, 0.422; 95% CI, 0.212– 0.842; P=0.014). In patients with reduced ejection fraction, SGLT2i significantly reduced the risk of MACEs (HR, 0.258; 95% CI, 0.106– 0.626; P=0.003) compared with the control group. By contrast, in patients without reduced ejection fraction, SGLT2i significantly reduced the risk of MACEs (HR, 0.640; 95% CI, 0.412– 0.996; P=0.048) and unplanned revascularisation (HR, 0.464; 95% CI, 0.222– 0.969; P=0.041) compared with the control group.Conclusion: In addition to significantly reducing the risk of adverse cardiovascular events and unplanned revascularisation in patients with ACS and T2D, the use of SGLT2i can reduce the risk of adverse cardiovascular events regardless of the presence of reduced ejection fraction.Keywords: sodium–glucose cotransporter 2 inhibitors, acute coronary syndrome, type 2 diabetes, cardiovascular outcomes