C-86 | Cardiovascular Outcomes After Transcatheter Aortic Valve Replacement in Patients With Opioid Use Disorder: A Propensity-Matched Real-World Study

Background: Patients with opioid use disorder undergoing transcatheter aortic valve replacement (TAVR) represents a high-risk population with increased burden of comorbidities and risk for periprocedural complications.However, the impact of opioid use disorder on post-TAVR cardiovascular outcomes remains poorly defined.Methods: We performed a retrospective cohort study using the Tri-NetX Research Network to identify adult patients who underwent transcatheter aortic valve replacement (TAVR).Patients with opioid use disorder were compared with those without.Propensity score matching was performed to balance baseline characteristics.Clinical outcomes were assessed at 3 years, and risk ratios were reported with 95% confidence intervals.Results: After propensity score matching, 3,404 patients undergoing TAVR were included.All-cause mortality was higher in the opioid group but did not reach statistical significance (18.5% vs 16.8%; P=0.19).Patients receiving opioids had significantly higher rates of major adverse cardiovascular events (MACE, 40.1% vs 33.5%; RR 1.20; P<0.001) and stroke (14.6% vs 11.0%; P=0.002), while rates of acute myocardial infarction were similar between groups.No significant differences were observed in bleeding events, pacemaker implantation, or ventricular arrhythmias.Conclusions: Among patients undergoing TAVR, peri-procedural opioid use was associated with higher rates of MACE and stroke, while all-cause mortality and other safety outcomes were similar.These findings highlight the need for cardiovascular risk assessment and post-procedural monitoring in this patient population.