Outcomes with transcatheter aortic valve replacement for aortic stenosis in rheumatoid arthritis: an observational study

Abstract

OBJECTIVE: To evaluate the short- and long-term clinical outcomes of transcatheter aortic valve replacement (TAVR) among participants with rheumatoid arthritis (RA) and aortic stenosis (AS) compared with those without RA, using real-world data from a large multicentre registry. METHODS: Using the TriNetX Registry, participants with AS undergoing TAVR with (RA+) vs without RA (RA-) were identified. Odds ratios (ORs) with 95% confidence intervals (CIs) estimated 30-day all-cause mortality, permanent pacemaker implantation, ischemic stroke, acute kidney injury, myocardial infarction, cardiogenic shock, major vascular complications, and major or life-threatening bleeding were evaluated. Five-year outcomes included all-cause mortality, ischemic stroke, MI, and all-cause hospitalization. Cox regression was used to estimate hazard ratios (HRs) with 95% CIs. RESULTS: 1,414 RA + (4.3%) and 39 004 RA- participants were eligible. After matching, 1,374 were included in each cohort. At 30 days, outcomes did not differ between RA+ and RA- groups; mortality was 2.0% vs 1.5% (OR 1.29; 95% CI 0.73-2.29), with no significant differences in other endpoints. Over 5 years, mortality was 23.8% vs 20.5% (OR 1.12; 95% CI 0.97-1.31), and stroke, MI, and hospitalization were similar; HRs were concordant with OR estimates. In sex-based analyses of RA patients, outcomes did not differ by sex. CONCLUSION: In this large observational study, TAVR was not associated with excess short- or long-term risk in patients with RA. These findings support TAVR as a safe therapeutic option in RA patients with aortic stenosis.