Efficacy of SGLT2 Inhibitors on Clinical Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular (CV) outcomes in patients with heart failure (HF) and type 2 diabetes. Their effect in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), however, remains unclear. This study evaluated whether SGLT2 inhibitors reduce all-cause mortality and HF hospitalisations after TAVR.<h4>Methods</h4>A systematic search of PubMed, ScienceDirect, Cochrane (CENTRAL), Scopus and Embase was performed through April 2025 for studies comparing post-TAVR outcomes between SGLT2 inhibitor users and non-users. Outcomes of interest included a composite of all-cause mortality or heart failure (HF) hospitalisation, along with the individual components of all-cause mortality and HF hospitalisation. All outcomes were extracted at 1 year. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was quantified using I² statistics. Analyses were conducted in R (version 4.4.2).<h4>Results</h4>Three studies (1 RCT, 2 Observational) comprising 3187 patients met inclusion criteria. SGLT2 inhibitor use was associated with a reduced risk of the composite outcome (HR: 0.75; 95% CI: 0.65, 0.86; p < 0.01). Individually, therapy lowered all-cause mortality (HR: 0.72; 95% CI: 0.53, 0.96; p = 0.03) and HF hospitalisations (HR: 0.74; 95% CI: 0.61, 0.90; p < 0.01).<h4>Conclusion</h4>In patients with severe AS undergoing TAVR, SGLT2 inhibitors were associated with significant reductions in all-cause mortality and HF hospitalisations. These findings suggest a promising role for SGLT2 inhibitors in improving post-TAVR outcomes. However, given the limited data, larger randomised clinical trials are necessary to consolidate these findings.<h4>Trial registration</h4>CRD420251132729.