GLP-1 Receptor Agonists Significantly Reduce Infarct Size and Improve LVEF in Acute Myocardial Infarction Patients

Despite advances in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality. Current therapies focus on reperfusion and preventing further damage, but strategies to directly limit infarct size and preserve cardiac function are still needed. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated broad cardioprotective effects beyond glycemic control, including benefits in heart failure and atherosclerosis. However, their specific efficacy in the acute phase of myocardial infarction, particularly in reducing infarct size and improving left ventricular function, has not been definitively established, representing a critical gap this meta-analysis addresses.

Researchers conducted a systematic review and meta-analyses, adhering to PRISMA guidelines, by searching major databases (MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, Google Scholar) through February 2026. The review included both randomized controlled trials (RCTs) and observational studies, but only RCTs were incorporated into the meta-analyses. The primary outcome assessed was infarct size relative to the area at risk (AAR). Secondary outcomes included major adverse cardiovascular events (MACE) and safety endpoints like nausea, hypoglycemia, and pancreatitis. Risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies.

The meta-analysis included eight studies with a total of 1,483 participants. GLP-1 RAs significantly reduced infarct size indexed to the AAR compared with placebo. The mean reduction observed was 10.14% points (95% confidence interval [CI]: -14.11--6.17; P < 0.001). This primary infarct-size analysis was based on only three RCTs. Furthermore, GLP-1 RAs led to a significant improvement in left ventricular ejection fraction (LVEF).