Abstract Body (Do not enter title and authors here): Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have effectively reduced cardiovascular mortality and hospitalizations in heart failure with preserved ejection fraction (HFpEF). This study investigates their effects on patients with HFpEF after an acute myocardial infarction (AMI), focusing on long-term outcomes.

Aims: The study aims to determine whether an SGLT2 inhibitor (SGLT2i) can improve cardiovascular morbidity and mortality.

Methods: Using TriNetX, a health research network accessing data from over 100 million patients globally, AMI patients with HFpEF (identified by NYHA Class 2-4, diagnosis code, and EF>50%) treated with and without SGLT2i were identified. Equal cohorts of 1,675 patients were created, and propensity scores were matched for demographics, medical history, medications, and lab values. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. Survival analysis was conducted at intervals ranging from 30 days to 5 years post-AMI to determine the efficacy of SGLT2i, examining MACE and its component outcomes.

Results: The analysis included 3,350 post-AMI patients between 2014 and 2023, with a mean age of 69.7 ± 11.4 years, 46.1% female. Of the SGLT2i group, 90.8% had T2DM compared to 91% of the non-SGLT2i group. The SGLT2i group had significantly lower 30-day mortality (2.6% versus 7.4%, P<0.0001) and MACE (58.6% versus 64.3%, P=0.002). Over a 5 year period, the SGLT2i group exhibited lower mortality (32.5% versus 55.8%, HR 0.767, P<0.0001) and a lower rate of MACE (58.6% versus 64.3%, HR 0.818, 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: SGLT2i use post-AMI in HFpEF patients was associated with improved survival and reduced rates of MACE and further MI. These results support further investigation into the inclusion of SGLT2i in therapeutic strategies for HFpEF patients post-AMI.