Abstract 4144446: Efficacy and Safety of Empagliflozin after Acute Myocardial Infarction: A Systematic Review and Meta Analysis

Introduction: Empagliflozin, a sodium–glucose co-transporter-2 (SGLT-2) inhibitor, improves cardiovascular outcomes in patients with heart failure (HF) with or without diabetes mellitus. However, limited data is available regarding its impact after acute myocardial infarction (AMI). Therefore, we aimed in our meta-analysis to evaluate the safety and efficacy of empagliflozin after AMI. Methods: We searched PubMed, Scopus, Cochrane Library, and Web of Science from inception to April 19th, 2024, to identify any Randomized Controlled trials (RCTs) that compare empagliflozin to placebo after AMI. The safety outcomes were presented as short term cardiovascular mortality, all-cause mortality, hospitalization for heart failure (HF), and any adverse events. The efficacy outcomes were reported as NT-proBNP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and LDL-c. Dichotomous outcomes were pooled in the form of risk ratio (RR), and continuous outcomes in form of mean difference (MD), with the corresponding 95% confidence intervals (CI). Results: Ten RCTs with a total of 10,697 patients were included. Empagliflozin was associated with significant lower risk of cardiovascular mortality (RR = 0.57, 95% CI [0.46, 0.71]), all cause mortality, and hospitalization for heart failure, (RR=0.64, 95% CI [0.53, 0.79]), (RR = 0.67, 95% CI [0.58, 0.79]), respectively. Furthermore, empagliflozin demonstrated a significant reduction in both NT-proBNP (MD = -161.26, 95% CI [-294.58, -27.93]) and SBP (MD= -8.59, 95% CI [-13.26, -3.93]). However, there is no difference between the two groups in terms of any adverse events, diastolic blood pressure, and LDL-c, (RR=0.98, 95% CI [0.95, 1.02]), (MD = -2.55, 95% CI [-5.31,0.20]), (MD=1.67, 95% CI [-6.11, 9.46]), respectively. Conclusion: Our meta analysis reveals that empagliflozin significantly reduce all major cardiovascular outcomes after AMI such as cardiovascular mortality and hospitalization due to heart failure. Moreover, empagliflozin effectively lowers NT-proBNP levels and SBP with no superiority in terms of adverse events, diastolic blood pressure and LDL-c.