Abstract Body (Do not enter title and authors here): Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have a Class 2a indication for treating heart failure with preserved ejection fraction (HFpEF). Despite established benefits in heart failure management, their effects post-acute myocardial infarction (AMI) have not been fully explored.

Aims: We aim to determine if an SGLT2 inhibitor (SGLT2i) may be associated with improved cardiovascular morbidity and mortality.

Methods: Patients with AMI treated with or without SGLT2i were identified using the TriNetX global health network, which includes data from over 100 million patients. Propensity score matching utilizing demographic, medical, procedural, medication, and laboratory information created two cohorts of 18,546 patients. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. Survival analyses between 30 days and 5 years post-AMI were set to assess cohort outcomes, examining MACE and its individual component outcomes.

Results: The analysis included 21,032 post-AMI patients between 2014 and 2023, with a mean age of 68.6 ± 11.4 years, 40.5% female. Of the SGLT2i group, 83.2% had T2DM compared to 84.8% of the non-SGLT2i group. The SGLT2i group had significantly lower 30-day mortality (2.6% versus 6.3%, P<0.0001) and MACE (38.0% versus 44.2%, P=0.002). Over a 5-year period, the SGLT2i group exhibited significantly lower mortality (41.3% versus 56.1% HR 0.704, P<0.0001) and a lower rate of MACE (58.6% versus 109.2%, HR 0.860, P<0.0001). Other outcomes, including MI, stroke, and bleeding events, also favored the SGLT2i group at both 30 days and 5 years (P<0.0001).

Conclusions: This study showed that the use of SGLT2i post-AMI in patients with normal EF was associated with decreased mortality, MACE, AMI, and stroke. These results advocate for the further investigation of SGLT2i in the post-AMI care path, highlighting their potential to improve post-AMI outcomes.