# Empagliflozin and Colchicine in Patients With Reduced Left Ventricular Ejection Fraction Following ST-Elevation Myocardial Infarction: A Systematic Review

## TL;DR

This review examines how empagliflozin and colchicine affect heart function after a heart attack in patients with weak heart pumping.

## Contribution

The study systematically reviews the efficacy and safety of empagliflozin and colchicine in post-STEMI patients with reduced LVEF.

## Key findings

- Empagliflozin improved LVEF and reduced heart failure hospitalizations.
- Colchicine reduced inflammation but had inconsistent effects on heart outcomes.
- Colchicine was linked to more side effects and potential risks like ventricular thrombus.

## Abstract

Patients with reduced left ventricular ejection fraction (LVEF) following ST-elevation myocardial infarction (STEMI) are at a high risk for heart failure (HF), adverse ventricular remodeling, and cardiovascular mortality. Empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, and colchicine, an anti-inflammatory agent, have been proposed as adjunctive therapies to mitigate post-myocardial infarction (MI) complications. A systematic review of randomized controlled trials (RCTs) published in English between January 2015 and June 2025 was conducted using PubMed, Embase, and Cochrane Library. Fourteen RCTs were included. Risk of bias assessment using Cochrane RoB 2.0 classified five studies as low risk and eight as of some concern. Evaluating empagliflozin or colchicine in post-STEMI patients with LVEF <45% was conducted. Key outcomes included changes in LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP), HF hospitalization, mortality, inflammatory biomarkers (CRP, creatine kinase-myocardial band (CK-MB)), and safety profiles. The Cochrane Risk of Bias 2.0 was used for quality assessment, and data were synthesized thematically. Visual summaries were generated using the robvis tool. The review indicated that empagliflozin consistently improved LVEF by 1.5%-5.7%, reduced NT-proBNP by approximately 15%, and lowered HF hospitalization risk, though it did not significantly reduce all-cause mortality. Colchicine reduced inflammatory markers (CRP, CK-MB) and recurrent ischemic events, but its effects on LVEF and HF outcomes were inconsistent. Colchicine was also associated with a higher incidence of gastrointestinal side effects and an increased risk of left ventricular thrombus formation. Empagliflozin showed consistent benefits in improving ventricular function and reducing HF hospitalizations after STEMI in patients with type 2 diabetes and should be prioritized in this setting. Colchicine provided potential anti-inflammatory and ischemic protection but demonstrates inconsistent cardiovascular efficacy and notable tolerability concerns. Further high-quality RCTs are required to clarify its role.