Sodium-Glucose Cotransporter 2 Inhibitors as Discharge Medications in Survivors of Acute Myocardial Infarction Complicated by Cardiogenic Shock
Amin Daoulah, Ahmed Jamjoom, Amr A. Arafat, Nooraldaem Yousif, Wael Almahmeed, Abdulrahman Arabi, Prashanth Panduranga, Amir Lotfi, Mokhtar Abdirahman Kahin, Hatem M. Aloui, Omar Kanbr, Jassim Alswuaidi, Bandar Alamro, Mohammed Alshehri, Waleed Alharbi, Badr Alzahrani, Sultan Al Obaikan, Khalid Z Alshali, Abdullah Alenezi, Said Al Maashani, Rajesh Rajan, Mohammed A. Qutub, Mohammed Balghith, Taher Hassan, Abdulrahman M. Alqahtani, Ibrahim A M Abdulhabeeb, Mohamed Ajaz Ghani, Adnan Fathey Hussien, Abeer M. Shawky, Youssef Elmahrouk, Shaber Seraj, Ahmed ElmahroukBackground:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure and after myocardial infarction (MI), but patients with cardiogenic shock (CS) have been excluded from major trials. We therefore evaluated the association between discharge SGLT2 inhibitor prescription and 1-year outcomes in survivors of acute myocardial infarction (AMI) complicated by CS.
Methods:
This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models.
Results:
Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462–1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629–1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients.
Conclusions:
In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.