Impact of SGLT2 inhibitors on long-term outcomes in TAVI patients with heart failure: a propensity-matched analysis

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure (HF), but their role in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. A recent randomized trial (DapaTAVI) showed reduced HF hospitalizations with SGLT2i post-TAVI, but effects on mortality and broader outcomes are unknown.

Using the TriNetX Research Network, we conducted a multicenter retrospective cohort study of adults with HF who underwent TAVI between 2015 and 2025. Patients prescribed SGLT2i within 30 days of TAVI were 1:1 propensity score-matched to nonusers. The primary outcome was all-cause mortality; secondary outcomes included hospitalizations, myocardial infarction, stroke, arrhythmias, and renal events.

Among 58 193 TAVI recipients, 3022 SGLT2i users were matched to 3022 nonusers. SGLT2i use was associated with significantly lower mortality at 3 months (3.5% vs 4.9%; HR, 0.71), 6 months (5.0% vs 8.1%; HR, 0.61), 12 months (7.3% vs 10.5%; HR, 0.71), and 5 years (10.7% vs 20.6%; HR, 0.59; all P <.01). SGLT2i users also had fewer hospital or emergency room visits and a lower 5-year incidence of myocardial infarction (12.0% vs 14.4%; OR, 0.81, P=.007). Stroke incidence was lower at 6 months (4.8% vs 6.1%; P=.041) but was not sustained long term. Renal and arrhythmic outcomes were similar between groups.

SGLT2i use in patients with HF undergoing TAVI was associated with reduced mortality and fewer adverse cardiovascular events. These findings support the integration of SGLT2i into post-TAVI management strategies.