Abstract 4365694: Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Mortality and Cardiovascular Outcomes Following TAVR in Heart Failure Patients: A Propensity-Matched Cohort Study

Abstract

Introduction/Background: SGLT2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits in patients with heart failure (HF), yet their effect in individuals undergoing transcatheter aortic valve replacement (TAVR) remains insufficiently characterized. Given the high prevalence of HF among TAVR recipients, we aimed to evaluate the long-term outcomes associated with SGLT2i use in this population. Research Question/Hypothesis: We hypothesized that SGLT2i use near the time of TAVR would be associated with reduced all-cause mortality and major cardiovascular events in patients with HF. Methods/Approach: Using the TriNetX Research Network, we conducted a multicenter retrospective cohort study including adults with HF who underwent TAVR between 2015 and 2025. Patients prescribed SGLT2i within 30 days of TAVR were 1:1 propensity score-matched to non-users based on demographics, comorbidities, medications, and laboratory data. Outcomes were assessed at 3 months, 6 months, 12 months, and 5 years. The primary outcome was all-cause mortality; secondary outcomes included myocardial infarction (MI), stroke, hospitalizations, arrhythmias, and renal events. Hazard ratios (HR) and odds ratios (OR) were calculated with 95% confidence intervals (CI). Results/Data: A total of 6,044 patients (3,022 in each group) were included. SGLT2i use was associated with significantly reduced all-cause mortality at 3 months (3.5% vs. 4.9%; HR 0.71; 95% CI, 0.55–0.92; P=0.006), 6 months (5.0% vs. 8.1%; HR 0.61; 95% CI, 0.50–0.76; P<0.001), 12 months (7.3% vs. 10.5%; HR 0.71; 95% CI, 0.60–0.85; P<0.001), and 5 years (10.7% vs. 20.6%; HR 0.59; 95% CI, 0.51–0.67; P<0.001). At 5 years, SGLT2i use was also associated with lower incidence of MI (12.0% vs. 14.4%; OR 0.81; 95% CI, 0.70–0.94; P=0.007) and hospital/emergency visits (51.0% vs. 62.5%; OR 0.63; 95% CI, 0.56–0.69; P<0.001). Stroke reduction was noted at 6 months (4.8% vs. 6.1%; OR 0.79; 95% CI, 0.62–0.99; P=0.041) but not sustained long term. There were no statistically significant differences in arrhythmia or renal event rates between cohorts. Conclusion(s): SGLT2i use in HF patients undergoing TAVR was independently associated with significantly lower mortality and fewer adverse cardiovascular outcomes over five years. These findings support early initiation of SGLT2i as part of post-TAVR medical therapy and warrant further prospective investigation