Background/Purpose: Patients with autoimmune connective tissue disease, such as Systemic Lupus Erythematosus (SLE), are at higher risk for developing aortic valve pathology. However, the impact of the presence of SLE on outcomes of Transcatheter aortic valve implantation (TAVI) has not been well described in the literature. We studied mortality, complications, readmission rates, and length of stay on a propensity-matched national cohort of SLE patients undergoing TAVI.

Methods: We queried the Nationwide readmission database from 2016-2020 using ICD 10 codes to extract the baseline population who underwent the TAVR procedure. Patients were identified and divided into two groups based on the presence of SLE. The Clinical outcomes were assessed at index admissions and readmissions using chi-square statistics, univariate and multivariate regression analysis using STATA v.17

Results: A total of 320,353 weighted index hospitalizations with TAVI were identified from 2016 to 2020. Out of which 1,348 patients had SLE while 319,005 patients did not. The mean age of the SLE group was 72.12 +/- 10.53 years while the non-SLE group was 79 +/- 8.53 years. The non-SLE group had a statistically significant higher prevalence of hyperlipidemia (73.21% vs 69.74%, p: < 0.001); smoking (35.64% vs 30.06%, p:0.0116); and prior PCI (19.4% vs 13.23%, p:0.0007); prior CABG (15.88% vs 10.06; p:0.0003) compared to the SLE group. While the SLE group had a higher prevalence of pulmonary disease (25.28% vs 20.58%, p: 0.01); hypothyroidism (26.92% vs 18.6%, p < 0.0001); anemia (8.38% vs 5.15%, p:0.00014) and liver disease (2.71% vs 1.51%, p:0.0256). There was no statistically significant difference in the crude and propensity-matched in-hospital outcomes including death, acute kidney injury, acute stroke, heart failure, myocardial infarction, use of mechanical circulatory support, post-procedural bleeding, cardiac tamponade, and Major adverse cardiac and cerebrovascular events (MACCE) among SLE and non-SLE groups. The multivariate regression analysis did not show statistically significant higher odds of SLE for the outcomes mentioned above. The mean length of stay at index hospitalization in the SLE group was 5.63 +/- 8.44 days while the non-SLE group was 4.14 +/- 6.21 days. The SLE patients had higher rates of hospital readmission at 1 month (10.01% vs 9.31%) and 6 months (18.02% vs 13.05%).

Conclusion: In conclusion, SLE does not appear to be a risk factor for in-hospital mortality and the studied post-procedural complications in patients undergoing TAVI. However, patients with SLE who underwent TAVI were younger and differed significantly at baseline comorbidities, compared to patients without SLE. Patients with SLE had longer lengths of stay and higher readmission rates after TAVI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/decoding-the-impact-of-systemic-lupus-erythematosus-on-transcatheter-aortic-valve-implantation-a-nationwide-population-based-study/