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EFFICACY OF SGLT2 INHIBITORS IN HIGH-RISK PATIENTS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: A META-ANALYSIS OF RANDOMIZED AND ADJUSTED DATA
Topic: Valvular disorders
Type: Presentation - doctors , Number in the programme: 502
Faizollah Zadeh Ardebili S. 1, Toni George Khairallah T. 2, Hantschick Fernandes Monteiro D. 3, De Paula Portilho N. 4

1 Department of Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, 2 Department of Medicine, The University of Georgia, Tbilisi, Georgia, 3 Harvard T. H. Chan School of Public Health, Harvard University, Boston, United States, 4 Department of Cardiology, Federal District Military Firefighter Brigade, Brasília, Brazil


Aim: High-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) have a high burden of heart failure readmissions and mortality. This population was excluded from large trials evaluating the use of sodium glucose cotransporter 2 inhibitors (SGLT2i). To address this gap, we performed a meta-analysis of high-risk TAVI patients comparing SGLT2i use versus no SGLT2i use.

Sample and Methodology: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials and multivariable adjusted studies to minimize the risk of confounding. Hazard ratios (HR) with corresponding 95% confidence intervals (CI) were pooled with a random effects model. Our primary outcome was a composite of heart failure hospitalizations (HFH) and all-cause mortality (ACM) at ≥ 1 year follow-up; secondary outcomes included HFH and ACM as individual endpoints.

Results: Two studies were included, one randomized and one adjusted, comprising 1,533 patients. The SGLT2i group had 44% of participants, with a minimum follow-up of 1 year. Compared to control, SGLT2i led to statistically significant reductions in the composite outcome (HR 0.65; 95% CI 0.44-0.95; p = 0.027; Figure 1), and the risk of HFH (HR 0.52; 95% CI 0.31-0.88; p = 0.015; Figure 2). No significant difference was observed between groups for ACM (HR 0.72; 95% CI 0.44-1.19; p = 0.20; Figure 3). 

Conclusion: This meta-analysis of randomized and adjusted studies suggests that SGLT2i significantly reduce the risk of HFH in high-risk patients who have undergone TAVI.