Therapeutic impact of SGLT2 inhibitors following transcatheter aortic valve implantation: a grade-assessed systematic review and meta-analysis.

BACKGROUND

We aim to evaluate the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

METHODS

We conducted a PRISMA-guided systematic review and meta-analysis of studies comparing SGLT2 inhibitor therapy with standard care in adults undergoing TAVI. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched from inception to November 2025. Outcomes included all-cause mortality, heart failure (HF) hospitalization, myocardial infarction (MI), cardiac death, stroke, pacemaker implantation, acute kidney injury (AKI), and bleeding events. Effect sizes were pooled using random-effects models, while time-to-event data were reconstructed for survival analyses.

RESULTS

Four studies comprising 12,374 patients were included. SGLT2 inhibitor therapy significantly reduced all-cause mortality (RR 0.62, 95% CI 0.49–0.78), HF hospitalization (RR 0.67, 95% CI 0.50–0.91), MI (RR 0.83, 95% CI 0.73–0.93), and bleeding events (RR 0.81, 95% CI 0.72–0.90). Effects on cardiac death, stroke, pacemaker implantation, and AKI were not statistically significant (P > 0.05).

CONCLUSION

SGLT2 inhibitor therapy in patients undergoing TAVI was associated with reductions in all-cause mortality, HF hospitalization, and MI. However, these findings are based on a limited and heterogeneous evidence base, largely derived from observational studies, and should be interpreted with caution. The results should not be considered definitive or generalizable to all TAVI populations. Further adequately powered randomized trials are required.