The efficacy and safety of Empagliflozin on outcomes of patients with myocardial infarction undergoing primary PCI: a systematic review and meta-analysis

Empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, has garnered significant interest due to its potential cardiovascular benefits, particularly in patients experiencing acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI). This systematic review aims to evaluate the effectiveness of Empagliflozin in improving clinical outcomes in this patient population. A systematic review of randomized controlled trials (RCTs) was conducted to assess the effects of Empagliflozin on clinical outcomes in patients with AMI undergoing primary PCI. Electronic databases, including PubMed, Scopus, Web of Science, Cochrane, and the Scientific Information Database, were searched up to July 31, 2024. The risk of bias in the included studies was evaluated using the Cochrane Collaboration criteria. Data analysis was performed using Comprehensive Meta-Analysis software version 3, with outcomes expressed as risk ratios (RR) and 95% confidence intervals (CI). Seven studies were included in the meta-analysis. The results demonstrated that Empagliflozin significantly reduced the risk of heart failure hospitalization compared to placebo, with a risk ratio of 0.48 (95% CI: 0.23-0.99; P = 0.049), indicating a 52% reduction in hospitalization risk. However, secondary outcomes showed that Empagliflozin was associated with a reduction in cardiovascular mortality (RR = 0.45; 95% CI: 0.06-3.02; P = 0.415) and the need for coronary revascularization (RR = 0.75; 95% CI: 0.15-3.59; P = 0.717), although these results did not achieve statistical significance. Empagliflozin is associated with a significant reduction in heart failure hospitalizations among patients with AMI undergoing primary PCI, while its effects on cardiovascular mortality and the necessity for coronary revascularization were not statistically significant. Despite these secondary outcomes, the favorable safety profile of Empagliflozin supports its use as a treatment option for high-risk patients following acute coronary events. Further research is warranted to investigate the long-term impact of Empagliflozin on cardiovascular outcomes in this population.