Sodium Glucose Co-Transporter 2 Inhibitors in Patients With Heart Failure and Transcatheter Aortic Valve Replacement

BACKGROUND: Patients undergoing transcatheter aortic valve replacement (TAVR) have a high risk of adverse cardiovascular outcomes due to comorbid conditions such as congestive heart failure (CHF). Recent trials show promising results of sodium glucose co-transporter 2 inhibitors in CHF patients. OBJECTIVES: In this observational cohort study, we aim to explore the cardiovascular outcomes of SGLT2 inhibitors vs standard care in CHF patients undergoing TAVR using a large research network database. METHODS: A retrospective cohort analysis of deidentified, aggregate patient data from the TriNETX research network was conducted. Subjects with CHF who underwent a TAVR procedure, were ≥18 years old, and received either SGLT2 inhibitors or standard of care were included in the analysis. After propensity score matching, outcomes were reported at 6-month and 1-year follow-up. The primary outcome was a composite of acute myocardial infarction, stroke, all-cause mortality, and acute CHF. RESULTS: A total of 21,828 CHF patients undergoing TAVR were identified, of whom 2,464 were on SGLT2 inhibitors therapy. Following propensity score matching, 2,039 patients were included in each group. The primary composite outcome was not statistically different at 6 months among patients receiving SGLT2 inhibitors compared to those receiving standard care (HR: 0.79; P = 0.067). SGLT2 inhibitors use was associated with a significantly lower risk of acute myocardial infarction (HR: 0.69; P = 0.043) and all-cause hospitalization/emergency room visits (HR: 0.69; P < 0.001). At 1 year, no significant differences were observed for the primary and individual endpoints except for all-cause hospitalizations (HR: 0.73; P < 0.001) and urinary tract infections (HR: 0.77; P = 0.009). CONCLUSIONS: Among CHF patients undergoing TAVR, SGLT2i use was not associated with a reduced risk of the primary composite outcome at 6-months and 1-year intervals.