The effect of SGLT2i on cardiovascular outcomes after PCI in patients with AMI and type 2 diabetes mellitus: a retrospective clinical study

To evaluate the association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) use and cardiovascular outcomes after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) complicated with type 2 diabetes mellitus (T2DM). A retrospective analysis was performed on 184 patients diagnosed with AMI complicated with T2DM who underwent PCI in the Department of Cardiology of the Fourth Hospital of Hebei Medical University from January 2021 to June 2024. Patients were divided into the SGLT2i group ( n = 93, SGLT2i combined with conventional therapy) and the control group ( n = 91, conventional therapy alone) according to regular post-discharge SGLT2i use. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular death, recurrent AMI, unstable angina pectoris, heart failure readmission, and stroke. Secondary endpoints included individual MACE components, unplanned revascularization, and in-stent restenosis of the original target vessel. The occurrence of endpoint events within 18 months of follow-up was compared between groups. Compared with the control group, the SGLT2i group had a significantly lower 18-month MACE incidence (16.1% vs. 33.0%, P = 0.013), as well as reduced recurrent AMI (2.2% vs. 9.9%, P = 0.032) and in-stent restenosis of the original target vessel (5.4% vs. 15.4%, P = 0.047). Multivariate Cox regression analysis confirmed SGLT2i use as an independent factor associated with lower MACE risk (HR = 0.497, P = 0.028) and multi-vessel disease as an independent factor associated with higher MACE risk (HR = 2.954, P = 0.003) in AMI patients with T2DM. Subgroup analysis revealed a more pronounced association between SGLT2i use and favorable cardiovascular outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and glycated hemoglobin (HbA1c) ≥ 6.5%. In this single-center retrospective cohort, post-discharge SGLT2i use was associated with a significantly lower 18-month incidence of MACE, recurrent AMI, and in-stent restenosis of the original target vessel in AMI patients with T2DM after PCI. These observational findings suggest an association rather than a causal effect and should be interpreted as hypothesis-generating, with associations appearing more pronounced in NSTEMI patients and those with HbA1c ≥ 6.5%. Confirmation in prospective randomized trials is required before SGLT2i can be firmly recommended for secondary prevention in this population.