Effects of SGLT2 inhibitors on inflammation and infarct size in diabetic patients with acute myocardial infarction

Introduction Non-ST-segment elevation myocardial infarction (NSTEMI) in patients with type 2 diabetes mellitus (T2DM) is frequently associated with increased inflammation and myocardial injury. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) show cardiovascular benefits in chronic care, but their role in acute ischemia remains uncertain. Objective To assess whether chronic use of SGLT2-I in T2DM patients admitted for NSTEMI is associated with reduced systemic inflammation, infarct size, and improved left ventricular function. Method This retrospective, monocentric study included 60 T2DM patients hospitalized for NSTEMI at Abderrahmen Mami Hospital between December 2024 and April 2025. Patients were divided into two groups: 21 on chronic SGLT2-I (Dapagliflozin, ≥ 3 months use) and 39 without prior SGLT2-I therapy, initiation of SGLT2-I was planned upon discharge. Inflammatory markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)), infarct size (peak troponin, affected myocardial segments), and left ventricular ejection fraction (LVEF) were assessed. HbA1c and renal function (eGFR) were also evaluated. Results SGLT2-I users had significantly lower CRP (17.8 ± 20.1 vs 35.7 ± 32.8 mg/L, P = 0.011), NLR (2.9 ± 1.1 vs 3.9 ± 1.6, P = 0.02), and PLR (102.5 ± 35.2 vs 132.1 ± 48.7, P = 0.03) ( Fig. 1 ). Peak troponin was markedly reduced (1273.6 ± 1473, median: 500 ng/L vs 6100.2 ± 10824 ng/L, median: 1200 ng/L, P = 0.009). LVEF, assessed by the Simpson biplane method, was significantly higher in the SGLT2-I group: 53.0 ± 9.4% (median: 52.7%), with 71.4% of patients having LVEF > 50%, compared to 48.0 ± 10.1% (median: 47.7%) and 38.5% with LVEF > 50% in the non-SGLT2-I group ( P = 0.002), with fewer affected myocardial segments (1.6 vs 2.4). HbA 1C was lower (7.7 ± 1.5% vs 8.5 ± 1.2%, P = 0.16), though not significant. Renal function was assessed using the MDRD formula. Two patients (3.3%) had an estimated glomerular filtration rate below 30 mL/min/1.73 m 2 , both from the non-SGLT2-I group. Overall, 96.7% of patients had an eGFR above 30 mL/min/1.73 m 2 . Conclusion Chronic SGLT2-I use in T2DM with NSTEMI may be associated with reduced inflammation, smaller infarcts, and better cardiac function.