A systematic review and meta-analyses of glucagon-like peptide-1 receptor agonists in acute myocardial infarction.

backgroundPrevious research has shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have cardioprotective effects. However, their efficacy in acute myocardial infarction (AMI) is not yet well established. We conducted a systematic review and meta-analyses to assess the impact of GLP-1 RAs in AMI.

methodsWe systematically searched major databases for studies in patients with ST-elevation (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). These included MEDLINE (accessed via PubMed), Excerpta Medica dataBASE (Embase), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar from their inception through February 2026. PRISMA guidelines were used to conduct this review. Both randomized controlled trials (RCTs) and observational studies were included in the systematic review. However, only RCTs were included in the meta-analyses. The primary outcome was infarct size relative to the area at risk (AAR). Secondary outcomes included major adverse cardiovascular events (MACE) and safety outcomes (nausea, hypoglycemia, pancreatitis). The Cochrane Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale (NOS) were used to assess risk of bias.

resultsWe included eight studies with a total of 1,483 participants. GLP-1 RAs led to a smaller infarct size indexed to the AAR compared with placebo. The mean reduction was 10.14% points (95% confidence interval [CI]: -14.11--6.17; P < 0.001). The primary infarct-size analysis was based on only three RCTs. GLP-1 RAs led to an improvement in the left ventricular ejection fraction (LVEF). The absolute mean improvement was 2.93% points (95% CI: 0.18-5.67; P < 0.05). Subgroup analyses were conducted to explore the findings in greater detail. They revealed that liraglutide was associated with an even higher absolute increase in LVEF. The absolute mean improvement was 5.32% points (95% CI: 3.49-7.15; P < 0.01). Nausea was more frequent in the treatment group, while hypoglycemia and pancreatitis were not significantly increased. Limitations included relatively small sample sizes in the individual studies, short follow-up periods, and variability in study designs.

conclusionsIn patients with AMI, GLP-1 RAs reduce relative infarct size and improve LVEF. No clear safety signal was detected in the available short-term trial data, except for increased nausea. These results indicate that GLP-1 RAs could be beneficial as an additional treatment in AMI.