Importance: Glucagon-like peptide-1 (GLP-1) protects against ischemia-reperfusion injury in patients with acute myocardial infarction (AMI). Controversy exists on the effects of GLP-1 on AMI patients undergoing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.
Study objective: We aimed to investigate the cardioprotective effects of GLP-1 in AMI patients after PCI and CABG.
Design: We searched PubMed, Web of Science, EBSCO, Scopus, and the Cochrane Library for relevant randomized controlled trials (RCTs) up to June 2021, with no restriction on publication date. The following search terms are used: "percutaneous coronary intervention" or "coronary artery bypass grafting" or "myocardial infarction" and "glucagon-like peptide 1" or "exenatide" or "liraglutide".
Study selection: Articles were independently assessed by 2 reviewers. We included RCTs only that compared GLP-1 with control in AMI patients.
Data extraction and synthesis: Continuous data were pooled as mean differences (MDs), while dichotomous variables were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software (meta package) for windows. Subgroup analysis according to the intervention type and GLP-agents were conducted. We assessed the heterogeneity among RCTs using the Q statistic and I2 statistic. We also tested publication bias by funnel plot-based methods. The quality of each study was assessed with the Cochrane risk of bias tool.
Main outcomes and measures: Primary outcomes were changes of left ventricular ejection fraction (LVEF), myocardial infarct characteristics, salvage index. Secondary outcomes included major adverse cardiac events (MACE), gastrointestinal events, and hypoglycemia.
Results: Nine RCTs (14 reports) including 1216 patients were included in this meta-analysis. At 3 months follow up, GLP-1 was associated with improved LVEF (MD = 2.81, 95% CI [0.69, 4.94]), infarct size in grams (MD = -5.71, 95% CI [-10.24, -1.18]), and salvage index (MD = 0.09, 95% CI [0.05, 0.14]). While, GLP-1 had less MACE rate than control (RR = 0.64, 95% CI [0.41, 0.99]), and higher gastrointestinal side effects (RR = 4.21, 95% CI [2.39, 7.41]).
Conclusions and relevance: This meta-analysis illustrated that GLP-1 was associated with better LVEF and reduced infarct size in patients with AMI undergoing PCI and CABG surgery, although the mechanism on how this agent provide this benefit is not clear.
Key points: Question: What is the effectiveness of Glucagon-like peptide-1 (GLP-1) agonist in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.Findings: This systematic review and meta-analysis illustrated that GLP-1 was associated with better left ventricular ejection fraction and reduced infarct size in patients with AMI undergoing PCI and CABG surgery, probably by reducing reperfusion injury.Meaning: GLP-1 could improve systolic and diastolic function, lowering the cardiovascular risk of morbidity and mortality in AMI patients.
Keywords: Coronary artery bypass grafting; Glucagon-like peptide-1; Myocardial infarction; Percutaneous coronary intervention; meta-analysis.
© 2021 The Authors.