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

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2026-10-01 Epub Date: 2026-08-13 DOI:10.1016/j.jscai.2026.105561

Muhammad Hanif MBBS, Waasay H. Khan MBBS, Shiva P. Sah MBBS, Jai S. Nagarajan MBBS, Jenish Bhandari MBBS, Stephen J. Knohl MD, Cynthia C. Taub MD, MBA, Andrew M. Weinberg DO, Ankur Kalra MD, MSc

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Abstract

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.

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糖尿病患者经导管主动脉瓣置换术后钠-葡萄糖共转运蛋白-2抑制剂的临床疗效：一项全球回顾性研究

背景：经导管主动脉瓣置换术（TAVR）是主动脉瓣狭窄的标准治疗方法，适合老年或高危患者。各种并发症，包括心力衰竭（HF），导致死亡率增加，已在文献中报道。无论射血分数如何，HF患者推荐使用钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）；然而，它们在减少tavr后心血管并发症中的作用仍未得到充分探讨。我们进行了一项回顾性研究，以评估与tavr后患者使用SGLT2i相关的心血管结局。方法本回顾性队列研究基于超过1.6亿患者的全球电子健康记录数据库。在倾向评分匹配后，研究人群包括9930名tavr后糖尿病患者，根据他们对SGLT2i的暴露分为2组。SGLT2i暴露定义为TAVR 1天后的暴露。结果在9930例tavr后糖尿病患者中，sgltti暴露的tavr后患者在1个月和1年的随访中，主要不良心血管事件的主要结局和次要结局，即心血管死亡率、缺血性卒中和心衰加重，均显著降低。出血性卒中在1个月的随访中具有可比性；然而，在1年随访中，暴露于sgltti的队列中，这一数值明显较低。1个月时新发心肌梗死的风险显著降低；然而，在1年的随访中，两个队列之间具有可比性。我们的研究还表明，在1年的随访中，sgltti暴露队列的终末期肾病风险显著降低。sgltti暴露组的围手术期（TAVR后7天内）以及随访1个月和1年的急性肾损伤风险显著降低。在这项研究中，tavr后糖尿病患者使用SGLT2i可降低心血管发病率和死亡率长达1年。

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