Efficacy and safety of empagliflozin for the acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials

This study aims to evaluate the efficacy and safety of empagliflozin in acute myocardial infarction (AMI) treatment by synthesizing evidence from published randomized controlled trials (RCTs). PubMed, Web of Science, Embase, and Cochrane databases were thoroughly retrieved from inception to November 30, 2024, to identify eligible RCTs comparing empagliflozin with placebo in AMI treatment. The Cochrane Risk of Bias tool was leveraged to detect potential bias. The robustness of the results was examined via sensitivity analyses. Publication bias was evaluated via funnel plots and Egger’s test. Data from 9 RCTs involving 7,237 AMI patients were analyzed. Meta-analysis revealed that empagliflozin significantly reduced the total hospitalization rate for heart failure (HF) in AMI patients in comparison to placebo (relative risk [RR] = 0.70, 95% confidence interval [CI] = 0.57–0.85). Additionally, empagliflozin significantly improved their ejection fraction (EF) (standard mean difference [SMD] = 1.01, 95% CI = 0.63–1.38), left ventricular global longitudinal strain (LVGLS) (SMD = −0.27, 95% CI = −0.48 to −0.06), body weight (SMD = −0.80, 95% CI = −1.15 to −0.45), and systolic blood pressure (SBP) (SMD = −0.54, 95% CI = −0.88 to −0.20). Statistically significant differences were not noted in other parameters (all p > 0.05). The incidence of adverse events (AEs), such as hepatic dysfunction, contrast-induced nephropathy, and urinary tract infections, did not differ significantly across groups (all p > 0.05). The GRADE rating indicated the evidence for HF hospitalization rate and body weight was of high certainty. Empagliflozin lowers the total hospitalization rate for HF in AMI patients and significantly improves EF, LVGLS, body weight, and SBP without raising the likelihood of AEs. This study aims to shed light on the efficacy and safety of empagliflozin in AMI treatment by synthesizing evidence from published randomized controlled trials (RCTs).Empagliflozin reduces the total hospitalization rate for HF in AMI patients and significantly improves EF, LVGLS, body weight, and SBP without raising the likelihood of AEs. This study aims to shed light on the efficacy and safety of empagliflozin in AMI treatment by synthesizing evidence from published randomized controlled trials (RCTs). Empagliflozin reduces the total hospitalization rate for HF in AMI patients and significantly improves EF, LVGLS, body weight, and SBP without raising the likelihood of AEs.