Sodium-Glucose Cotransporter-2 Inhibitor Use and Outcomes Following Transcatheter Aortic Valve Replacement: A Propensity-Score Matched Analysis.

BACKGROUND

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to improve outcomes across all heart failure (HF) phenotypes, but their role in patients undergoing transcatheter aortic valve replacement (TAVR) remains limited.

METHODS

Using the TriNetX Global Collaborative Network, we identified all adults undergoing TAVR (2019-2025). Patients were divided into 2 groups - those receiving SGLT2i within 1-year post-TAVR and matched controls not receiving SGLT2i. Propensity-score matching was applied across demographics, comorbidities, medications, and labs. The primary endpoint was a composite of all-cause mortality and HF exacerbation. Secondary outcomes included major adverse cardiac and cerebrovascular events, ischemic stroke, acute myocardial infarction, and all-cause rehospitalization at 1 and 5 years.

RESULTS

Among 55,147 TAVR patients, 2,478 (4.5%) received SGLT2i. After 1:1 matching, 2,020 well-balanced patients per group were analyzed. At 1 year, SGLT2i use was associated with lower incidence of primary composite endpoint (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.69-0.80), HF exacerbation (HR 0.44, 95% CI 0.31-0.62), and all-cause rehospitalization (HR 0.41, 95% CI 0.38-0.44). Benefits persisted at 5 years with additional reduction in all-cause mortality (HR 0.84, 95% CI 0.73-0.97). Acute pancreatitis (falsification outcome) showed no association at both follow-ups.

CONCLUSIONS

In a large multinational database, SGLT2i therapy after TAVR resulted in a significantly lower incidence of all-cause mortality or HF exacerbation.