Abstract 4366313: SGLT-2 Inhibitors Reduce Mortality and Heart Failure Hospitalizations Following TAVR in Severe Aortic Stenosis: A Meta-Analysis

Introduction/Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce cardiovascular morbidity and mortality in patients with heart failure and type 2 diabetes. However, their role in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis remains uncertain. Research Question: Does the use of SGLT2 inhibitors after transcatheter aortic valve replacement reduce all-cause mortality and heart failure hospitalizations in patients with severe aortic stenosis? Methods: We searched the PubMed, ScienceDirect, and Cochrane CENTRAL databases up until April 2025 for studies comparing outcomes in SGLT2i users versus non-users after TAVR. Patients not receiving SGLT2 inhibitors were considered the control group and were compared to those receiving SGLT2 inhibitors following TAVR. The outcomes of interest included the composite endpoint (all-cause mortality or heart failure [HF] hospitalization), as well as each component individually. Pooled hazard ratios (HRs) with 95% confidence intervals (95% CIs) were derived using a random-effects model. Heterogeneity was assessed using I 2 statistics. Analyses was performed using Review Manager 5.4. Results: Three studies (n = 3,187) met the eligibility criteria: 1,506 patients received SGLT2i and 1,681 served as controls. SGLT2i use was associated with a 25% lower risk of the composite endpoint at one year (HR: 0.74; [95% CI: 0.63 - 0.87]; p < 0.001). Individually, SGLT2i therapy reduced all-cause mortality (HR: 0.69; [95% CI: 0.49 - 0.96]; p = 0.03) and HF hospitalizations (HR: 0.72; [95% CI: 0.55 - 0.93]; p = 0.01). Heterogeneity was low (I 2 < 25%), and bias assessments indicated acceptable study quality. Conclusion: In severe aortic stenosis patients undergoing TAVR, SGLT2i therapy is linked to significant reductions in mortality and HF hospitalizations. These findings support the potential role of SGLT2 inhibitors in enhancing post-TAVR outcomes and highlight the need for larger prospective trials