Myocardial infarction (MI) without established heart failure (HF) represents a distinct high-risk condition that is not sufficiently represented in other trial populations. Early intervention with disease-modifying therapies, such as Sodium-Glucose Co-transporter 2 inhibitors (SGLT2i), could potentially prevent progression to chronic HF in these patients. Prior trials involving patients with type 2 diabetes mellitus (T2DM), HF, or nephropathy have predominantly focused on stable outpatients and have generally excluded patients with recent acute cardiovascular events. While there is a growing interest in the potential benefits of SGLT2 inhibitors in the acute MI setting, further research is essential to determine their efficacy and safety in this patient population. This will require well-designed, targeted clinical trials that specifically address the unique characteristics and needs of patients with acute MI, including those with new onset left ventricular dysfunction, transient HF, or concurrent T2DM. Furthermore, the safety profile of SGLT2 inhibitors in post-MI patients appears to be favorable, as they have been found to have a comparable incidence of serious adverse events to placebo. This is an important consideration, as safety is a paramount concern when introducing new therapies, especially in a vulnerable patient population like those recovering from an acute MI. It is important to conduct further research to determine whether the early introduction of SGLT2 inhibitors post-MI can lead to similar benefits as those observed in patients with T2DM and established cardiovascular disease.
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