{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:02:07Z","timestamp":1790341327328,"version":"4.1.0"},"reference-count":20,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Sodium\u2013glucose cotransporter-2 (SGLT2) inhibitors improve cardiorenal outcomes in patients with diabetes, heart failure, and chronic kidney disease. Their association with perioperative outcomes after major cardiac procedures remains uncertain. Methods: In this retrospective cohort study using the TriNetX U.S. Collaborative Network, adults (\u226518 years) undergoing cardiac procedures were identified. Patients with documented SGLT2 inhibitor use within 1 year before the index procedure were compared with non-users. Risk ratios (RR), risk differences, Kaplan\u2013Meier survival curves, and Cox models were used for analysis. Results: Of 150,724 patients identified, 7526 propensity score-matched pairs were analyzed. The matched cohorts had a mean age of 65.8 \u00b1 10.6 years and were predominantly male (70.5% male, 29.5% female). Preoperative SGLT2 inhibitor use was associated with significantly lower all-cause mortality at 30 days (1.3% vs. 2.3%; RR 0.566 [95% CI 0.443\u20130.722], p &lt; 0.001), 90 days (2.2% vs. 3.4%; RR 0.643, p &lt; 0.001), and 1 year (3.8% vs. 5.8%; RR 0.657, p &lt; 0.001). MACE rates were similar between groups at all time points. Acute kidney injury at 30 days was lower with SGLT2 inhibitors (15.4% vs. 17.7%; RR 0.870, p &lt; 0.001), whereas hospital admission rates were higher (76.4% vs. 68.7%; RR 1.111 [95% CI 1.089\u20131.133], p &lt; 0.001). These associations were consistent in diabetes-only and obesity-only subgroups and in a 30-day landmark sensitivity analysis. Conclusions: In this large, contemporary, multi-institutional propensity score-matched cohort, preoperative SGLT2 inhibitor use was associated with reduced all-cause mortality and acute kidney injury after major cardiac procedures. These real-world findings support the conduct of dedicated randomized trials evaluating perioperative SGLT2 inhibitor therapy.<\/jats:p>","DOI":"10.3390\/jcm15176808","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:56:01Z","timestamp":1788339361000},"page":"6808","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative SGLT2 Inhibitor Use and Outcomes After Major Cardiac Procedures: A Propensity Score-Matched Analysis of the TriNetX Network"],"prefix":"10.3390","volume":"15","author":[{"given":"Mirza","family":"Khawar","sequence":"first","affiliation":[{"name":"Services Institute of Medical Sciences, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faizan","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, NJ 07753, 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Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7931-0846","authenticated-orcid":false,"given":"Minahil","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Medicine, Shalamar Medical and Dental College, Lahore 54840, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Ali","family":"Shuja","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Faculty of Pharmacy, Salim Habib University, Karachi 74900, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Afzal","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Khalida Memorial Institute of Allied & Medical Sciences, Sialkot 51310, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Naheed","family":"Sajjad","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sardar Bahadur Khan Women University, Quetta 87300, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Muhammad","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Fergana Medical Institute of Public Health, Fergana 150100, Uzbekistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9740-3305","authenticated-orcid":false,"given":"Meeran","family":"Atta","sequence":"additional","affiliation":[{"name":"Services Institute of Medical Sciences, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4117-6138","authenticated-orcid":false,"given":"Umair","family":"Arshad","sequence":"additional","affiliation":[{"name":"Services Institute of Medical Sciences, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7051-7413","authenticated-orcid":false,"given":"Muneeb","family":"Khawar","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7357-8624","authenticated-orcid":false,"given":"Nazila","family":"Dalir","sequence":"additional","affiliation":[{"name":"School of Medicine, St. George\u2019s University, St. George\u2019s 00000, Grenada"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7057-9975","authenticated-orcid":false,"given":"Haris","family":"Tahir","sequence":"additional","affiliation":[{"name":"Lahore General Hospital, Lahore 54000, 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