Sodium-Glucose Cotransporter 2 Inhibitors as Discharge Medications in Survivors of Acute Myocardial Infarction Complicated by Cardiogenic Shock
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: 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.
Source: Shock
Authors: 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 Elmahrouk
Institutions: King Faisal Specialist Hospital & Research Centre, Tanta University, Ministry of Defense, Research and Innovation Institute, Cleveland Clinic Abu Dhabi, Hamad Medical Corporation, Royal Hospital, Baystate Medical Center, University of Massachusetts Chan Medical School, Baystate Health, International Medical Center in Jeddah, King Saud Medical City, Elrazi University, King Saud University, King Abdulaziz Medical City, National Guard Health Affairs, King Abdulaziz University, Chest Diseases Hospital, Sultan Qaboos Hospital, Amiri Hospital, King Saud bin Abdulaziz University for Health Sciences, Bugshan Hospital, King Fahd Medical City, King's College London, Al-Azhar University
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: hybrid
OpenAlex ID: W7166832068
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