Continuing sodium-glucose cotransporter-2 inhibitors after transcatheter aortic valve implantation improves survival and renal outcomes
Y Chuang, M Chuang, C Wang, T LiuAbstract
Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) provide significant cardiorenal benefits, yet are frequently discontinued after transcatheter aortic valve implantation (TAVI) due to perioperative safety concerns. The clinical impact of this discontinuation remains unknown.
Purpose
We aimed to evaluate the real-world efficacy and safety of continuing SGLT2i after TAVI, hypothesizing that continuation improves survival and cardiorenal outcomes without increasing perioperative adverse events
Methods
We conducted a retrospective study using the TriNetX Global Collaborative Network. We identified adult patients who underwent TAVI and possessed an active SGLT2i prescription before their TAVI procedure. Patients were stratified into a 3-month post-TAVI continuation cohort versus a discontinuation cohort, with follow-up extending up to one year. To mitigate immortal time bias, active 6-month follow-up was required. Following 1:1 propensity score matching (PSM), 1-year Kaplan-Meier survival analysis assessed mortality, progression to end-stage renal disease (ESRD), hospitalization, new-onset atrial fibrillation (AFib), and safety outcomes.
Results
Propensity score matching established two well-balanced, high-risk cohorts (N=1,104 each) with excellent cohort balance (all standard mean differences <0.10). The matched population had a mean age of 76.3 years, a baseline ejection fraction of ~52%, and high burdens of diabetes (78%) and chronic kidney disease (53%). Over the 1-year follow-up, SGLT2i continuation conferred a 29% relative reduction in all-cause mortality (HR 0.71, 95% CI 0.52–0.96, p=0.026) and a profound 55% reduction in progression to ESRD (HR 0.45, 95% CI 0.25–0.81, p=0.006). Continuation also significantly decreased all-cause hospitalizations (HR 0.84, p=0.011) and new-onset AFib (HR 0.83, p=0.021). No significant differences existed for heart failure (HR 1.01, p=0.89), stroke, or myocardial infarction. Crucially, continuing SGLT2i demonstrated excellent renal and hemodynamic safety, with no increased risk of acute kidney injury (HR 0.98, 95% CI 0.79–1.20, p=0.82), clinically significant hypotension (HR 1.12, p=0.28), or urinary tract infections (HR 0.80, p=0.11).
Conclusion
Continuing SGLT2i after TAVI safely reduces mortality, progression to ESRD, hospitalizations, and new-onset AFib without increasing perioperative risks. These findings strongly challenge routine perioperative cessation, suggesting clinicians should proactively maintain SGLT2i therapy post-discharge to optimize patient survival and preserve renal function.Forest plot of all the endpointsKaplan-Meier estimates of major endpoints