Glucose-lowering therapies have increasingly demonstrated cardiovascular benefits, but direct comparisons between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) following acute myocardial infarction (AMI) remain limited. Understanding comparative outcomes may help inform treatment selection in patients undergoing percutaneous coronary intervention (PCI).

In a multicenter retrospective cohort study using the TriNetX US Collaborative Network, investigators compared clinical outcomes among adults with AMI who underwent PCI and initiated either a GLP-1 RA or an SGLT2 inhibitor within 14 days of the index event. The findings were published in the Catheterization & Cardiovascular Interventions. The analysis included 7,201 GLP-1 RA users and 4,252 SGLT2 inhibitor users before propensity score matching.

After one-to-one propensity score matching across more than 50 baseline characteristics, 1,752 patients remained in each treatment group. Outcomes were assessed using Kaplan-Meier and Cox proportional hazards analyses, with follow-up extending to one year.

Findings

• Compared with SGLT2 inhibitors, GLP-1 receptor agonists were associated with a lower risk of acute heart failure at 1 year (HR, 0.415; 95% CI, 0.343–0.501).
• GLP-1 receptor agonists were associated with lower risks of all-cause hospitalization (HR, 0.559; 95% CI, 0.495–0.631), recurrent myocardial infarction (HR, 0.799; 95% CI, 0.710–0.899), and stroke (HR, 0.800; 95% CI, 0.667–0.959).
• Lower risks of atrial fibrillation (HR, 0.804; 95% CI, 0.693–0.932), major adverse cardiovascular events (HR, 0.788; 95% CI, 0.706–0.881), and acute kidney injury (HR, 0.534; 95% CI, 0.444–0.643) were also observed with GLP-1 receptor agonists.
• At 30 days, GLP-1 receptor agonists were associated with lower absolute risks of acute heart failure, with an absolute risk reduction of 7.19% (95% CI, 5.66%–8.72%), and all-cause hospitalization, with an absolute risk reduction of 16.61% (95% CI, 14.24%–18.98%).
• All-cause mortality did not differ significantly at 30 or 90 days but was lower among GLP-1 receptor agonist users at 1 year (HR, 0.700; 95% CI, 0.507–0.967), while rates of cardiac arrest were similar between groups.

The findings suggest that initiation of a GLP-1 receptor agonist after AMI and PCI was associated with lower risks of several cardiovascular and renal outcomes compared with SGLT2 inhibitor therapy.