Perioperative complications such as postoperative atrial fibrillation (POAF) and acute kidney injury (AKI) remain common in patients undergoing cardiac surgery and interventional procedures. While sodium-glucose cotransporter 2 inhibitors (SGLT2i) have established cardiovascular and renal benefits in non-surgical settings, their role in procedural care remains under evaluation. A meta-analysis presented at ACC.26 assessed the impact of SGLT2i use in this setting.

The analysis included 16 studies with a total of 5,129 individuals undergoing cardiac procedures. Data were sourced from PubMed, Embase, and clinical trial registries through September 2025. Eligible studies compared SGLT2i with placebo or other glucose-lowering therapies. Pooled outcomes were reported as odds ratios (ORs) with 95% confidence intervals.

SGLT2i use during procedures was associated with a lower risk of POAF (OR 0.36; p=0.01). A reduction in AKI risk was also observed (OR 0.53; p=0.02). Reductions in all-cause mortality (p=0.08) and heart failure hospitalization (p=0.07) were observed but did not reach statistical significance.

No significant differences were reported for cardiovascular mortality or urinary tract infection risk. A higher occurrence of diabetic ketoacidosis (DKA) was observed with SGLT2i use; however, this did not reach statistical significance (p=0.06).

These findings indicate that SGLT2i use during cardiac procedures was associated with lower risks of POAF and AKI. Effects on mortality and heart failure hospitalization were not statistically significant, and the potential increase in DKA requires further evaluation. Ongoing research is needed to define optimal timing and patient selection for SGLT2i use in procedural settings.