Authors: Labaste F, Pey V, Marcheix B, Ferre F, Vardon F, Minville V
Anesthesia & Analgesia ():10.1213/ANE.0000000000007705
This single-center, retrospective propensity score–matched study evaluated the effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on postoperative cardiovascular outcomes in patients with chronic heart failure undergoing scheduled cardiac surgery with cardiopulmonary bypass (CPB). Among 241 eligible patients, 172 were matched into two groups based on preoperative SGLT2i exposure. The primary composite endpoint included postoperative myocardial injury (PMI), low cardiac output syndrome (LCOS), and 30-day mortality.
The SGLT2i group experienced significantly fewer primary outcome events compared to controls (26.7% vs 41.9%, OR 0.51, P = .04), primarily driven by a reduced incidence of PMI (15.1% vs 41.9%, OR 0.46, P = .04). Secondary findings included lower postoperative lactate levels, reduced troponin T peaks, and a lower rate of postoperative delirium. No significant differences were found in LCOS, inotrope/vasopressor use, or mortality.
The authors suggest that SGLT2i may confer perioperative cardioprotection, potentially by altering myocardial energy metabolism during ischemia-reperfusion. These results challenge current recommendations to discontinue SGLT2i before surgery due to the risk of euglycemic ketoacidosis, underscoring the need for randomized trials to evaluate the benefit–risk profile of perioperative continuation.
References
Authors: Labaste F, Pey V, Marcheix B, Ferre F, Vardon F, Minville V
Anesthesia & Analgesia ():10.1213/ANE.0000000000007705
Thank you to Anesthesia & Analgesia for allowing the use of this article.