Impact of SGLT2 inhibitors on long-term outcomes in TAVI patients with heart failure: a propensity-matched analysis

Document Type

Article

Publication Date

11-11-2025

Publication Title

Rev Esp Cardiol (Engl Ed)

Keywords

Heart failure; Insuficiencia cardiaca; Mortalidad; Mortality; SGLT2; TAVI

Abstract

INTRODUCTION AND OBJECTIVES: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure (HF), but their role in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. A recent randomized trial (DapaTAVI) showed reduced HF hospitalizations with SGLT2i post-TAVI, but effects on mortality and broader outcomes are unknown.

METHODS: Using the TriNetX Research Network, we conducted a multicenter retrospective cohort study of adults with HF who underwent TAVI between 2015 and 2025. Patients prescribed SGLT2i within 30 days of TAVI were 1:1 propensity score-matched to nonusers. The primary outcome was all-cause mortality; secondary outcomes included hospitalizations, myocardial infarction, stroke, arrhythmias, and renal events.

RESULTS: Among 58 193 TAVI recipients, 3022 SGLT2i users were matched to 3022 nonusers. SGLT2i use was associated with significantly lower mortality at 3 months (3.5% vs 4.9%; HR, 0.71), 6 months (5.0% vs 8.1%; HR, 0.61), 12 months (7.3% vs 10.5%; HR, 0.71), and 5 years (10.7% vs 20.6%; HR, 0.59; all P < .01). SGLT2i users also had fewer hospital or emergency room visits and a lower 5-year incidence of myocardial infarction (12.0% vs 14.4%; OR, 0.81, P=.007). Stroke incidence was lower at 6 months (4.8% vs 6.1%; P=.041) but was not sustained long term. Renal and arrhythmic outcomes were similar between groups.

CONCLUSIONS: SGLT2i use in patients with HF undergoing TAVI was associated with reduced mortality and fewer adverse cardiovascular events. These findings support the integration of SGLT2i into post-TAVI management strategies.

PubMed ID

41232829

ePublication

ePub ahead of print

Find It @ Sladen

Share

COinS