Sodium-Glucose Cotransporter 2 Inhibitors as Discharge Medications in Survivors of Acute Myocardial Infarction Complicated by Cardiogenic Shock

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure and after myocardial infarction (MI), but patients with cardiogenic shock (CS) have been excluded from major trials. We therefore evaluated the association between discharge SGLT2 inhibitor prescription and 1-year outcomes in survivors of acute myocardial infarction (AMI) complicated by CS. METHODS: This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models. RESULTS: Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629-1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients. CONCLUSIONS: In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.

Authors

Institutions

Publication Details

Journal
Shock
Published
2026-06-30
DOI
https://doi.org/10.1097/shk.0000000000002904
Primary Topic
Diabetes Treatment and Management
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Sodium-Glucose Cotransporter 2 Inhibitors as Discharge Medications in Survivors of Acute Myocardial Infarction Complicated by Cardiogenic Shock

Mohamed Ajaz Ghani, Adnan Fathey Hussien, Youssef Elmahrouk, Prashanth Panduranga et al.
Shock
Diabetes Treatment and Management
article

Sodium-Glucose Cotransporter 2 Inhibitors as Discharge Medications in Survivors of Acute Myocardial Infarction Complicated by Cardiogenic Shock

Mohamed Ajaz Ghani, Adnan Fathey Hussien, Youssef Elmahrouk, Prashanth Panduranga, Amin Daoulah, Bandar Alamro, Khalid Z. Alshali, Nooraldaem Yousif, Ahmed Jamjoom, Abdulrahman Arabi, Omar Kanbr, A Sahebghadam Lotfi, Shaber Seraj, Jassim Alswuaidi, Sultan Al Obaikan, Mokhtar Abdirahman Kahin, Abeer M. Shawky, Mohammed A. Qutub, Taher Hassan, Hatem Aloui, Mohammed Alshehri, A Arafat, Ahmed Elmahrouk, Badr Alzahrani, Waleed Alharbi, Mohammed Balghith, Ibrahim A M Abdulhabeeb, Said Al Maashani, Wael Almahmeed, Abdullah Alenezi, Rajesh Rajan, Abdulrahman M. Alqahtani
article en

Abstract

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure and after myocardial infarction (MI), but patients with cardiogenic shock (CS) have been excluded from major trials. We therefore evaluated the association between discharge SGLT2 inhibitor prescription and 1-year outcomes in survivors of acute myocardial infarction (AMI) complicated by CS. METHODS: This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models. RESULTS: Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629-1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients. CONCLUSIONS: In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.

Shock
University of Bahrain (BH), Ministry of Defence (GB), Cleveland Clinic (US), Baystate Medical Center (US), Prince Sultan University (SA), Al-Azhar University (EG), King Abdulaziz University (SA), King Saud bin Abdulaziz University for Health Sciences (SA), Tanta University (EG), King Faisal Specialist Hospital & Research Centre (SA), King Saud Medical City (SA), Sultan Qaboos Hospital (OM), King Fahd Medical City (SA), King Saud University (SA), Amiri Hospital (KW), Tanta University Hospital (EG), King Abdullah International Medical Research Center (SA), Bugshan Hospital (SA), Chest Diseases Hospital (KW), Baystate Health (US), Al-Sabah Hospital (KW), Royal Hospital (OM), King Abdulaziz Hospital (SA), King Fahad Hospital Jeddah (SA), Islamic University of Madinah (SA), Elrazi University, National Guard Health Affairs (SA), Hamad Medical Corporation (QA)
Good health and well-being
Openalex Percentile: Top 7%
Diabetes Treatment and Management
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.