Pre-PCI SGLT2 inhibitors and contrast-induced nephropathy in acute myocardial infarction: A meta-analysis.

BACKGROUND: Contrast-induced nephropathy (CIN), a common complication of percutaneous coronary intervention (PCI), adversely affects clinical outcomes by extending hospital stays and increasing healthcare costs. Importantly, CIN is linked to poor prognosis in acute myocardial infarction (AMI) patients. This study evaluated the preventive effect of pre-procedural sodium-glucose cotransporter-2 (SGLT2) inhibitors administration on CIN incidence in AMI patients who received PCI. METHODS: A systematic search of PubMed, Web of science, and the Cochrane Library was performed for studies published up to December 12, 2024. Observational studies and clinical trials investigating pre-procedural SGLT2 inhibitors use in PCI-treated AMI patients were included. Following PRISMA guidelines, 2 researchers independently screened the literature, extracted the data, and assessed the bias risk. Data synthesis utilized Review Manager 5.3 with a random-effects model to address heterogeneity. The primary outcomes included CIN incidence (95% confidence intervals (CI)). The secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), recurrent myocardial infarction, and heart failure (HF) readmission, which were analyzed via risk ratios(RR) and I² statistics. RESULTS: Five studies involving 3301 patients (SGLT2 inhibitors group: 665; control: 2636) were analyzed. Compared with the control group, the SGLT2 inhibitors group demonstrated significantly lower risks of CIN (RR: 0.55, 95% CI: 0.41-0.73, P < .0001), all-cause mortality (RR: 0.49, 95% CI: 0.29-0.81, P = .005), MACE (RR: 0.33, 95% CI: 0.17-0.65, P = .01), and HF readmission (RR: 0.30, 95% CI: 0.16-0.56, P = .0001). No significant difference was observed in the recurrent myocardial infarction rates (RR: 0.88, 95% CI: 0.38-2.06, P = .77). CONCLUSION: Pre-procedural SGLT2 inhibitors use significantly reduces CIN incidence, mortality, MACE, and HF readmission in PCI-treated AMI patients, suggesting potential cardiorenal protective benefits.