Peri-operative SGLT-2i use was associated with a significantly lower risk of major adverse cardiovascular events post-TAVI (HR 0.65; 95% CI 0.44-0.95; P=0.03).
Meta-Analysis (n=35,075)
Does peri-operative SGLT-2i use reduce major adverse cardiovascular events in patients undergoing TAVI?
Peri-operative SGLT-2i use in patients undergoing TAVI is associated with a lower risk of major adverse cardiovascular events, though evidence is primarily observational.
Hazard Ratio: 0.65 (95% CI 0.44–0.95)
p-value: p=0.03
BACKGROUND: Despite successful transcatheter aortic valve implantation (TAVI) for severe aortic stenosis, residual heart failure risk and postprocedural complications persist. OBJECTIVES: The aim was to assess the association between sodium glucose co-transporter 2 inhibitor (SGLT-2i) use and clinical outcomes in patients undergoing TAVI. METHODS: 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. RESULTS: 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; I CONCLUSIONS: 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.
“Previous trials have provided evidence for SGLT-2 inhibitors in patients with a variety of other conditions but have excluded patients with valvular heart disease. Based on our study, if you have a patient undergoing TAVI who is at risk of heart failure, it is important to treat them with dapagliflozin or another SGLT-2 inhibitor. These are safe drugs and have a lot of benefit.”
Mohammed et al. (Tue,) conducted a meta-analysis in Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=35,075). Sodium glucose co-transporter 2 inhibitor (SGLT-2i) was evaluated on Major adverse cardiovascular events (HR 0.65, 95% CI 0.44-0.95, p=0.03). Peri-operative SGLT-2i use was associated with a significantly lower risk of major adverse cardiovascular events post-TAVI (HR 0.65; 95% CI 0.44-0.95; P=0.03).