Outcomes of transcatheter aortic valve replacement in patients with rheumatologic diseases: A large-scale propensity-matched analysis

BACKGROUND Patients with rheumatologic diseases (RD) present unique challenges in cardiovascular care due to systemic inflammation and complex medical management. However, transcatheter aortic valve replacement (TAVR) outcomes in this population remain poorly characterized. METHODS Using the TriNetX database, we conducted a retrospective cohort study of patients undergoing TAVR between 2015 and 2023. Patients with RD (systemic lupus erythematosus, rheumatoid arthritis, or ankylosing spondylitis; n=4,447) were compared with non-RD patients (n=4,447) using 1:1 propensity score matching. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE), acute kidney injury, and other clinical endpoints. RESULTS After propensity matching, baseline characteristics were well-balanced. During follow-up, RD patients demonstrated higher all-cause mortality compared to non-RD patients (25.4% vs 23.2%; hazard ratio [HR] 1.069; [1.002-1.139]; P=0.043). Kaplan-Meier survival analysis showed gradual curve separation over time. RD patients experienced significantly higher rates of MACCE (41.9% vs 32.3%; HR 1.266; [1.062-1.511]; P=0.008), acute kidney injury (20.5% vs 18.0%; HR 1.140; [1.016-1.279]; P=0.025), myocardial infarction (11.9% vs 9.6%; HR 1.236; [1.083-1.410; P=0.004), and heart failure events (7.3% vs 6.1%; HR 1.195; [1.002-1.424]; P=0.047). In multivariable Cox regression of the entire matched cohort, prednisone use was associated with increased mortality (HR 1.215; [1.167-1.264]; P<0.001), while lipid-modifying agents showed protective effects (HR 0.947; [0.905-0.990]; P=0.016). CONCLUSIONS TAVR in RD patients was associated with modestly higher all-cause mortality and significantly increased cardiovascular complications compared to non-RD patients. Optimized medication management, particularly regarding corticosteroid use and lipid modification, may improve outcomes in this high-risk population.