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

Objective: To evaluate the short- and long-term clinical outcomes of transcatheter aortic valve replacement (TAVR) among participants with RA and aortic stenosis compared with those without RA, using real-world data from a large multicentre registry. Methods: Using the TriNetX Research Network, participants with aortic stenosis undergoing TAVR with (RA+) vs without (RA−) RA were identified. Odds ratios (ORs) with 95% CIs estimated 30-day all-cause mortality, permanent pacemaker implantation, ischaemic 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, ischaemic stroke, myocardial infarction and all-cause hospitalization. Cox regression was used to estimate hazard ratios (HRs) with 95% CIs. Results: A total of 1414 RA+ (4.3%) and 39 004 RA− participants were eligible. After matching, 1374 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, myocardial infarction 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.