Abstract：
Patients with diabetes mellitus (DM) are at higher risk of cardiovascular events, particularly acute myocardial infarction (MI). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) can improve cardiac outcomes among heart failure individuals, however, the effects on acute myocardial infarction remain unclear. This meta-analysis investigates the impact of empagliflozin in diabetic patients following acute myocardial infarction. We comprehensively searched PubMed, Scopus, Cochrane, and Web of Science through August 10th, 2023. We included studies comparing empagliflozin versus placebo in diabetes patients with acute myocardial infarction. We used Revman to report the data as mean difference (MD) and 95% confidence interval (CI), and our effect size with a random effects model. Additionally, we performed Trial Sequential Analysis (TSA) to test the robustness of the results. The study protocol was published on PROSPERO with ID: CRD42023447733. Five studies with a total of 751 patients were included in our analysis. Empagliflozin was effective to improve LVEF% (MD: 1.80, 95% CI [0.50, 3.10], p = 0.007), left ventricular end-diastolic volume (LVEDV) (MD: -9.93, 95% CI [-16.07, -3.80], p = 0.002), and left ventricular end-systolic volume (LVESV) (MD: -7.91, 95% CI [-11.93, -3.88], p = 0.0001). However, there was no difference between empagliflozin and placebo groups in terms of NT-pro BNP (MD: - 136.59, 95% CI [-293.43, 20.25], p = 0.09), and HbA1c (MD: -0.72, 95% CI [-1.73, 0.29], p = 0.16). Additionally, empagliflozin did not prevent hospitalization due to heart failure (RR: 0.59, 95% CI [0.16, 2.24], p = 0.44, I-squared = 0%), and mortality (RR: 1.34, 95% CI [0.15,11.90], p = 0.79, I-squared = 25%). Empagliflozin initiation in diabetic patients following acute MI may improve echocardiographic parameters. However, empagliflozin might not be effective in heart failure prevention and optimal glycemic control in this patient population. Further large-scale trials are warranted to ascertain our findings.
摘要：
糖尿病（DM）患者发生心血管事件的风险较高，特别是急性心肌梗死（MI）。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）可以改善心力衰竭个体的心脏预后，然而,对急性心肌梗死的影响尚不清楚.这项荟萃分析调查了依帕列净对急性心肌梗死后糖尿病患者的影响。我们全面搜索了PubMed，Scopus,科克伦,和WebofScience到8月10日，2023年。我们纳入了在糖尿病合并急性心肌梗死患者中比较依帕列净与安慰剂的研究。我们使用Revman将数据报告为平均差(MD)和95%置信区间(CI)，和随机效应模型的效应大小。此外,我们进行了试验序贯分析(TSA)以检验结果的稳健性.该研究方案发表在PROSPERO上，ID：CRD42023447733。我们的分析包括5项研究，共751名患者。Empagliflozin可有效提高LVEF％（MD：1.80，95％CI[0.50，3.10]，p=0.007),左心室舒张末期容积（LVEDV）（MD：-9.93，95%CI[-16.07，-3.80]，p=0.002),和左心室收缩末期容积（LVESV）（MD：-7.91，95％CI[-11.93，-3.88]，p=0.0001)。然而,在NT-proBNP方面，empagliflozin和安慰剂组之间没有差异（MD：-136.59，95％CI[-293.43，20.25]，p=0.09),和HbA1c（MD：-0.72，95%CI[-1.73，0.29]，p=0.16）。此外,empagliflozin不能预防因心力衰竭而住院（RR：0.59，95％CI[0.16，2.24]，p=0.44，I平方=0%)，和死亡率（RR：1.34，95%CI[0.15,11.90]，p=0.79，I平方=25%)。急性MI后糖尿病患者开始服用Empagliflozin可能会改善超声心动图参数。然而,在该患者人群中,依帕列净在心力衰竭预防和最佳血糖控制方面可能无效.需要进一步的大规模试验来确定我们的发现。
