Short-Term Efficacy of Early Sodium-Glucose Cotransporter 2 Inhibitor Initiation in Patients With Heart Failure After Acute Anterior Myocardial Infarction.

BACKGROUND: Patients with heart failure (HF) following acute anterior ST-segment elevation myocardial infarction (STEMI) are at high risk for adverse ventricular remodeling, and a significant residual risk persists despite optimal guideline-directed medical therapy (GDMT). Although sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated clear benefit in chronic HF, evidence is limited regarding the early initiation of these inhibitors after acute myocardial infarction (MI), particularly in patients with HF complicating anterior wall infarction. Therefore, this study aimed to evaluate the short-term effects of early initiation of the SGLT2 inhibitor (SGLT2i) empagliflozin, when added to standard medical therapy, on cardiac function and safety in patients with HF following acute anterior STEMI. METHODS: This single-center retrospective cohort study consecutively enrolled 98 patients hospitalized at Tianjin Union Medical Center between January 2022 and December 2022 with acute anterior STEMI complicated by HF. Patients were divided into two groups based on SGLT2i use: the control group (n = 49) received standard medical therapy alone, while the SGLT2i group (n = 49) received empagliflozin 10 mg once daily in addition to standard therapy. The primary outcome was the change in left ventricular ejection fraction (LVEF) from admission to one month after discharge. Analysis of covariance (ANCOVA) and multivariable linear regression models were employed to adjust for potential confounders. RESULTS: Baseline characteristics were well-balanced between the two groups. At one-month follow-up, the SGLT2i group showed a significantly greater improvement in LVEF than the control group, with a multivariable-adjusted effect size of 1.92% (95% confidence interval (CI): 0.44-3.40%; p = 0.012). Serum uric acid levels were significantly lower in the SGLT2i group than in the control group (p = 0.006). In both groups, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels decreased from baseline to one-month follow-up, with no significant between-group difference. The incidence of adverse events was similar between groups, and no cases of ketoacidosis or severe deterioration in renal function were observed. CONCLUSION: In hemodynamically stable patients with acute anterior STEMI complicated by HF, early initiation of SGLT2 inhibitors was associated with higher LVEF at 1 month and a trend toward lower uric acid levels, without significant differences in safety outcomes between groups. These preliminary findings suggest potential benefit and warrant confirmation in prospective studies.