Clinical Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors After Transcatheter Aortic Valve Replacement in Patients With Diabetes: A Global Retrospective Study

Background Transcatheter aortic valve replacement (TAVR), a standard therapy for aortic stenosis, is preferred for older or high-risk patients. Various complications, including heart failure (HF), resulting in increased mortality, have been reported in the literature. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended in HF, irrespective of ejection fraction; however, their role in reducing post-TAVR cardiovascular complications remains underexplored. We conducted a retrospective study to evaluate cardiovascular outcomes associated with the use of SGLT2i in post-TAVR patients. Methods This retrospective cohort was based on a global database of electronic health records of more than 160 million patients. After propensity-score matching, the study population included 9930 post-TAVR diabetic patients divided into 2 cohorts based on their exposure to SGLT2i. Exposure to SGLT2i was defined as exposure after 1 day of TAVR. Results In this study of 9930 post-TAVR diabetic patients, the primary outcome of major adverse cardiovascular events and secondary outcomes, ie, cardiovascular mortality, ischemic stroke, and HF exacerbation, were significantly reduced in SGLT2i-exposed post-TAVR patients at the 1-month and 1-year follow-up. Hemorrhagic stroke was comparable at the 1-month follow-up; however, it was significantly lower in SGLT2i-exposed cohorts at the 1-year follow-up. The risk of new-onset myocardial infarction was significantly reduced at 1 month; however, it was comparable between the 2 cohorts at the 1-year follow-up. Our study also demonstrated a significant reduction in the risk of end-stage renal disease in the SGLT2i-exposed cohort at the 1-year follow-up. The periprocedural risk of acute kidney injury (within 7 days of TAVR) as well as at the 1-month and 1-year follow-up was significantly lower in the SGLT2i-exposed cohort. Conclusions In this study, post-TAVR SGLT2i use in diabetic patients was associated with reduced cardiovascular morbidity and mortality for up to 1 year.