Early sodium‐glucose co‐transporter 2 inhibitor initiation is associated with improved cardiovascular outcomes in type 2 diabetes and acute coronary syndrome

AIMS: Sodium-glucose co-transporter 2 inhibitors have demonstrated cardiovascular benefits in individuals with type 2 diabetes mellitus, but the optimal timing of initiation in those with acute coronary syndrome is not known. This study aims to assess if early therapy at discharge is superior to delayed or no therapy in reduction in major adverse cardiovascular events. METHODS: This retrospective, observational cohort study included individuals with type 2 diabetes admitted with an acute coronary syndrome at a single regional heart centre between July 2018 and December 2023. Individuals were stratified into three groups based on the timing of sodium-glucose co-transporter 2 inhibitor initiation: (1) discharge group (initiated at hospital discharge), (2) post-discharge group (initiated after discharge during follow-up) and (3) no therapy group. The primary outcome was the first occurrence of a major adverse cardiovascular event. RESULTS: Among 970 eligible patients (median age, 70.2 years [IQR, 61.0-78.5 years]; 73.9% male), the median follow-up duration was 29.9 months (IQR, 20.1, 43.0 months). Compared with the discharge group, the risk of primary outcome was significantly higher in both the post-discharge group (adjusted hazard ratio [aHR], 1.50; 95% CI [1.13, 1.99], p = 0.005) and the no therapy group (aHR, 1.65; 95% CI [1.24, 2.20]; p < 0.001). Analyses were adjusted using clone-censor-weight methods and multivariable Cox-proportional hazards models. CONCLUSIONS: Sodium-glucose co-transporter 2 inhibitor therapy at hospital discharge was associated with a significantly lower risk of major adverse cardiovascular events in patients with type 2 diabetes and acute coronary syndrome.