The Impact of SGLT2 Inhibitors on Cardiac Remodeling After Myocardial Infarction: An Updated Meta-analysis of Randomized Controlled Trials

Mali Xu^1,2XinHui Li^1,2*Hui Wang^1,2Dan Ouyang^1,2Hang Qi¹

• ¹School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, China
• ²The Second Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, China, Changsha, China

Background: Recent studies show that SGLT2 inhibitors not only reduce blood glucose but also provide cardiovascular benefits, decreasing acute myocardial ischemia/reperfusion injury in patients with acute myocardial infarction. Objective: This meta-analysis aims to thoroughly assess the clinical effectiveness of SGLT2 inhibitors in the treatment of acute myocardial infarction. Methods: Randomized controlled trials evaluating the efficacy of SGLT2i in combination with guideline-directed medical therapy for acute myocardial infarction were retrieved from major databases: PubMed, Cochrane Library, Embase, Medline, and Web of Science. At the same time, clinical trial registries (ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform) were searched, covering all published literature up to May 2025. Using the Cochrane Collaboration for assessing the risk of bias, two independent reviewers went through preliminary screening and assessment of studies according to preset inclusion criteria. Meta-analysis was conducted using RevMan 5.4 software, and StataMP 16.0 was used to evaluate publication bias. The quality of evidence was graded according to recommended procedures for assessing and evaluating evidence. Results: Five randomized controlled trials with a total of 881 patients were included in this analysis. According to a meta-analysis, SGLT2 inhibitors and GDMT significantly reduced NT-proBNP (RR=-89.82, 95% CI -96.28 to -83.35; p<0.00001) and enhanced 12-week LVEF (RR=6.32, 95% CI -4.95 to 17.60; p<0.00001). Evaluation of additional cardiac structural and functional characteristics showed that the SGLT2i plus GDMT group significantly reduced LAV (RR=-3.86, 95% CI -6.33 to -1.38; p=0.002) and LAVI (RR=-1.67, 95% CI -3.13 to -0.20; p=0.03) when compared to the control group. There were decreases in LVESVI, LVEDVI, LVEDD, LVESD, LVESV, and LVEDV. Furthermore, subgroup analyses based on the LVEF at admission and the site of the infarct in AMI patients were carried out. SGLT2i plus GDMT treatment led to a significantly higher improvement in the LVEF≤40% group than in the LVEF>40% group. Conclusion: Available data suggest that SGLT2i intervention may ameliorate detrimental early ventricular remodeling in individuals who have had an acute myocardial infarction, improve cardiac function, and aid in the recovery of cardiac function and structure.