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 <i>via</i> sensitivity analyses. Publication bias was evaluated <i>via</i> 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 <i>p</i> &gt; 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 <i>p</i> &gt; 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.

本研究旨在通过整合已发表的随机对照试验（randomized controlled trials, RCTs）证据，评估恩格列净（empagliflozin）用于急性心肌梗死（acute myocardial infarction, AMI）治疗的有效性与安全性。本研究于各数据库建库起至2024年11月30日期间，全面检索PubMed、Web of Science、Embase及Cochrane数据库，筛选比较恩格列净与安慰剂治疗AMI的合格随机对照试验。采用Cochrane偏倚风险工具检测潜在偏倚；通过敏感性分析检验研究结果的稳健性，并利用漏斗图与Egger检验评估发表偏倚。最终共纳入9项RCTs，涉及7237名AMI患者并完成数据分析。

荟萃分析结果显示，与安慰剂相比，恩格列净可显著降低AMI患者因心力衰竭（heart failure, HF）住院的总发生率（相对风险[RR]=0.70，95%置信区间[CI]=0.57~0.85）。此外，恩格列净可显著改善患者的射血分数（ejection fraction, EF）（标准均数差[SMD]=1.01，95%CI=0.63~1.38）、左心室整体纵向应变（left ventricular global longitudinal strain, LVGLS）（SMD=-0.27，95%CI=-0.48~-0.06）、体质量（SMD=-0.80，95%CI=-1.15~-0.45）及收缩压（systolic blood pressure, SBP）（SMD=-0.54，95%CI=-0.88~-0.20）。其余观察指标未观察到统计学显著差异（所有p>0.05）。两组间肝功能异常、对比剂肾病、尿路感染等不良事件（adverse events, AEs）的发生率无显著差异（所有p>0.05）。GRADE分级显示，关于HF住院率与体质量的证据确定性等级为高。

恩格列净可降低AMI患者因HF住院的总发生率，并显著改善EF、LVGLS、体质量及SBP，且未增加不良事件发生风险。本研究旨在通过整合已发表的随机对照试验（randomized controlled trials, RCTs）证据，阐明恩格列净用于AMI治疗的有效性与安全性。恩格列净可降低AMI患者因HF住院的总发生率，并显著改善EF、LVGLS、体质量及SBP，且未增加不良事件发生风险。本研究旨在通过整合已发表的随机对照试验（randomized controlled trials, RCTs）证据，阐明恩格列净用于AMI治疗的有效性与安全性。恩格列净可降低AMI患者因HF住院的总发生率，并显著改善EF、LVGLS、体质量及SBP，且未增加不良事件发生风险。