Association of SGLT2i with Cardiovascular and Renal Outcomes After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Background Sodium–glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated consistent cardiovascular benefits across a broad range of high-risk populations. However, their role after transcatheter aortic valve implantation (TAVI) remains incompletely defined. Therefore, we conducted this study to comprehensively evaluate the association of SGLT2i therapy with mortality, heart failure, and renal outcomes after TAVI. Methods Randomized controlled trials and observational cohort studies comparing SGLT2i users with non-users or standard care were included. The prespecified outcomes were 1-year all-cause mortality, long-term all-cause mortality (follow-up ≥ 2 years), heart failure hospitalization, composite clinical endpoint, and acute kidney injury (AKI). Random-effects models pooled hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals (CI). Results Eight studies comprising 14785 patients were included. Post-TAVI SGLT2i therapy was associated with a lower risk of 1-year all-cause mortality (HR 0.72; 95% CI 0.61 to 0.84; p < 0.001), ≥ 2-year all-cause mortality (HR 0.59; 95% CI 0.51 to 0.67; p < 0.001), heart failure hospitalization (HR 0.63; 95% CI 0.44 to 0.91; p=0.013), composite clinical endpoint (HR 0.74; 95% CI 0.64 to 0.84; p < 0.001). In contrast, no significant overall reduction was observed for AKI (OR 0.68 95% CI 0.36 to 1.30; p=0.247). The 1-year mortality and HF hospitalization estimates were sensitive to omission of individual studies. Conclusions In patients undergoing TAVI, SGLT2i therapy was associated with lower risks of short- and long-term mortality, heart failure hospitalization, and composite clinical events, whereas no statistically significant association with AKI was observed.