SGLT-2 Inhibitors and Outcomes After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Despite successful transcatheter aortic valve implantation (TAVI) for severe aortic stenosis, residual heart failure risk and postprocedural complications persist.

The aim was to assess the association between sodium glucose co-transporter 2 inhibitor (SGLT-2i) use and clinical outcomes in patients undergoing TAVI.

A systematic search was conducted across PubMed, Cochrane Library, Google Scholar, ScienceDirect, and ClinicalTrials.gov for eligible randomized controlled trials (RCTs) and observational studies. Adjusted HRs and risk ratios were pooled for time-to-event outcomes and dichotomous outcomes, respectively. Risk of bias was assessed using the Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions-I tools for RCTs and cohort studies, respectively.

Six studies (1 RCT, 5 cohorts) including 35,075 patients were included in the analysis. In pooled analyses, SGLT-2i use was associated with a significantly lower risk of major adverse cardiovascular events (pooled HR: 0.65; 95% CI: 0.44-0.95; P = 0.03; I² = 26%), heart failure hospitalization (pooled HR: 0.58; 95% CI: 0.40-0.86; I² = 59%; P = 0.007), all-cause mortality (pooled HR: 0.71; 95% CI: 0.55-0.91; P = 0.007; I² = 75%), and cardiovascular death (pooled risk ratio: 0.55; 95% CI: 0.34-0.89; P = 0.01; I² = 36%). The Grading of Recommendations Assessment, Development, and Evaluation assessment was downgraded due to heterogeneity, potential bias, and nonrandomized design of studies.

This meta-analysis suggests that peri-operative SGLT-2i use was associated with lower cardiovascular events post-TAVI albeit with low certainty due to predominance of observational studies. These findings are hypothesis generating rather than causal inference. Future clinical trials are warranted.