SGLT2 Inhibitors Fail to Impact MI Severity or Outcomes in T2DM Patients: Study

The study, published in BMC Cardiovascular Disorders by Istvan Bojti and colleagues from the Department of Cardiology and Angiology, University Heart Center Freiburg – Bad Krozingen, examined whether ongoing SGLT2 inhibitor therapy influences infarct size and short-term outcomes in T2DM patients experiencing MI.

The research included 681 patients with T2DM who were admitted for MI and underwent PCI between November 2015 and December 2023. Among them, 105 were on SGLT2 inhibitors, while 576 were using other glucose-lowering medications at admission. The primary parameter assessed was infarct size, measured using peak high-sensitive troponin T (hs-TnT) normalized to the endangered myocardial area (EMA).

The analysis revealed the following findings:

• Analysis showed no significant difference in infarct size between patients on SGLT2 inhibitors and those using other glucose-lowering therapies.
• Median high-sensitive troponin T (hs-TnT) levels were similar in both groups.
• Adjusted statistical models indicated that ongoing SGLT2 inhibitor therapy was not associated with a reduction in MI size.
• Evaluation of in-hospital secondary outcomes, including major adverse events and ICU stay duration, showed no significant benefit linked to SGLT2 inhibitor use.

The authors hypothesize that any potential protective effect of SGLT2 inhibitors may have been offset by more severe coexisting cardiovascular conditions and poorer glycemic control observed in the SGLT2 inhibitor group. They also noted that the evolving prescription patterns during the study period, especially following the positive outcomes of SGLT2 inhibitors in heart failure patients, may have resulted in a higher proportion of patients with advanced cardiovascular disease in the SGLT2 inhibitor cohort.

The study’s real-world design was highlighted as a strength, as it included patients with multiple comorbidities who are often excluded from randomized clinical trials, such as those with prior coronary artery bypass grafting, significant renal impairment, or those on insulin therapy. However, the authors acknowledged several limitations, including the study’s retrospective nature, the absence of data on therapy duration or adherence, and the lack of detailed diabetes-related complications that could influence outcomes. They also emphasized that the method used for estimating infarct size may not be as accurate as cardiac MRI, which is considered the gold standard.

The authors note that while the findings do not demonstrate a significant relationship between ongoing SGLT2 inhibitor therapy and reduced infarct size or adverse in-hospital outcomes, they recommend further prospective studies, ideally incorporating cardiac MRI and diverse patient populations.

“Such investigations are needed to clarify whether SGLT2 inhibitors exert any protective effects in the setting of myocardial infarction, both in patients with and without T2DM,” the researchers concluded.

Reference:

Bojti, I., Bojti, F., Hartikainen, T. et al. SGLT2-inhibition and myocardial infarction size in patients with type 2 diabetes mellitus– Insights from an acute cardiovascular care center. BMC Cardiovasc Disord 25, 566 (2025). https://doi.org/10.1186/s12872-025-04981-5