Empagliflozin and Colchicine in Patients With Reduced Left Ventricular Ejection Fraction Following ST-Elevation Myocardial Infarction: A Systematic Review
Abstract
Patients with reduced left ventricular ejection fraction (LVEF) following ST-elevation myocardial infarction (STEMI) are at a high risk for heart failure (HF), adverse ventricular remodeling, and cardiovascular mortality. Empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, and colchicine, an anti-inflammatory agent, have been proposed as adjunctive therapies to mitigate post-myocardial infarction (MI) complications. A systematic review of randomized controlled trials (RCTs) published in English between January 2015 and June 2025 was conducted using PubMed, Embase, and Cochrane Library. Fourteen RCTs were included. Risk of bias assessment using Cochrane RoB 2.0 classified five studies as low risk and eight as of some concern. Evaluating empagliflozin or colchicine in post-STEMI patients with LVEF <45% was conducted. Key outcomes included changes in LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP), HF hospitalization, mortality, inflammatory biomarkers (CRP, creatine kinase-myocardial band (CK-MB)), and safety profiles. The Cochrane Risk of Bias 2.0 was used for quality assessment, and data were synthesized thematically. Visual summaries were generated using the robvis tool. The review indicated that empagliflozin consistently improved LVEF by 1.5%-5.7%, reduced NT-proBNP by approximately 15%, and lowered HF hospitalization risk, though it did not significantly reduce all-cause mortality. Colchicine reduced inflammatory markers (CRP, CK-MB) and…
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