Sodium–glucose cotransporter-2 (SGLT-2) Inhibitors in Ischemia Reperfusion Injury: A Systematic Review

Abstract

Abstract Background The effects of Sodium–glucose cotransporter-2 (SGLT-2) inhibitors on ischemia reperfusion injury (IRI) have been investigated by preclinical and clinical studies, however there is still lack of a net impact. Therefore, a systematic review is required to evaluate the impact of SGLT-2 inhibitors on myocardial IRI reduction. Methods We searched MEDLINE, Embase, and Cochrane Library from inception until August 7th, 2023. ClinicalTrials.gov was also explored for ongoing studies. Two authors independently conducted the literature search, examined the studies, and evaluated the eligibility criteria. Any disagreements or uncertainties were resolved by the corresponding author. The search strategy followed the PICO process (Population, Intervention, Comparison, and Outcome) and Emtree was used to select relevant keywords. Results Of 220 articles identified from the literature research, five articles were included in the study, of which three studies lately were retracted. The remaining studies included 1229 participants, with 209 receiving SGLT-2 inhibitors and 1090 not receiving them. All of the participants were diabetic patients admitted with acute myocardial infarction (AMI), undergoing percutaneous coronary intervention (PCI). The results demonstrated that the use of SGLT-2 inhibitors is associated with lower troponin levels, higher rates of ST resolution in admission. The results of the studies also showed smaller infarct sizes, lower inflammatory biomarkers and improved left ventricular function at discharge among SGLT-2 inhibitor users. Conclusion The reviewed articles provided benefits of SGLT-2 inhibitors in IRI through reducing infarct size and inflammatory biomarkers. Our conclusion is further supported by available in vivo and ex vivo findings.