# Early SGLT2 Inhibitor Therapy in Acute Coronary Syndrome: Mitigating Adverse Remodeling in High-Risk Phenotypes—A Real-World Study

## TL;DR

This study finds that early use of SGLT2 inhibitors in high-risk heart attack patients helps stabilize heart structure, even when patients start with worse health conditions.

## Contribution

The study demonstrates that early SGLT2 inhibitor therapy stabilizes cardiac structure in high-risk acute coronary syndrome patients, regardless of diabetes status.

## Key findings

- Early SGLT2 inhibitor therapy was associated with structural cardiac stabilization in high-risk ACS patients.
- Despite a higher baseline risk profile, SGLT2-treated patients achieved outcomes comparable to lower-risk controls.
- The benefits of SGLT2 inhibitors were consistent regardless of diabetes status.

## Abstract

Background and Objectives: SGLT2 inhibitors are foundational in heart failure therapy, yet their impact on left ventricular (LV) remodeling immediately following acute coronary syndrome (ACS) remains less defined. This study evaluated the association between early SGLT2 inhibitor initiation and structural recovery in a real-world post-ACS cohort. Materials and Methods: We conducted a retrospective observational study including 238 revascularized ACS patients, stratified into an SGLT2 inhibitor group (n = 71) and a control group (n = 167). Changes in LV ejection fraction (LVEF) and indexed LV mass (LVMi) were assessed by echocardiography at baseline and follow-up (mean 286 days). Multivariable regression models were adjusted for baseline imbalances and tested for interactions with diabetes status. Results: A significant “confounding by indication” was observed; the SGLT2 group presented a high-risk phenotype with higher diabetes prevalence (56.3% vs. 25.7%, p < 0.001), lower baseline LVEF (38.3% vs. 43.3%), and greater hypertrophy. After adjustment, statistical independence was attenuated by baseline severity, yet the SGLT2 group achieved follow-up structural outcomes comparable to lower-risk controls. Interaction analysis indicated these trends were consistent regardless of diabetes status (p > 0.05). Conclusions: In this high-risk ACS population, early SGLT2 inhibitor therapy was associated with stabilization of cardiac structure. Despite a profound baseline disadvantage, the recovery trajectory effectively aligned with that of a lower-risk population, highlighting a clinically relevant pattern of structural stabilization consistent across metabolic subgroups.