Lower Risk of Acute Ischemic Stroke Following Transcatheter Aortic Valve Implantation in Female Patients with Chronic Inflammatory Diseases: A Retrospective Analysis of National Inpatient Sample

Background Chronic inflammatory disease (CID) is associated with accelerated atherosclerosis and increased risk of aortic stenosis. Data regarding sex-specific outcomes after transcatheter aortic valve implantation (TAVI) in CID patients are lacking. We aimed to investigate sex differences in outcomes among patients with CID undergoing TAVI using a nationally representative database. Methods Using the National Inpatient Sample database (2016–2021), we identified CID patients who underwent TAVI. These conditions were classified into three subgroups: inflammatory arthritis, systemic autoimmune and organ-specific inflammatory diseases. Primary outcomes were acute ischemic stroke (AIS) and in-hospital mortality. We conducted stratified analyses by CID subgroups using multivariate logistic regression models, adjusting for demographic characteristics and comorbidities. Results Among 15,825 CID patients undergoing TAVI, females (n = 9,695) were less likely to be White (87.22% vs 92.06%) and had a lower burden of cardiovascular risk factors, including dyslipidemia (65.45% vs 75.04%), diabetes mellitus (28.88% vs 34.34%), prior coronary artery bypass grafting (4.28% vs 15.74%), and history of smoking (29.60% vs 51.22%). After adjustment for confounders, females demonstrated significantly lower rates of AIS (1.34% vs 2.37%; adjusted OR 0.50; 95% CI, 0.29–0.88), whereas in-hospital mortality was comparable between sexes (0.98% vs 0.73%, adjusted OR 0.96; 95% CI, 0.41–2.22). This sex-specific difference in AIS was most pronounced in the inflammatory arthritis subgroup (adjusted OR 0.34; 95% CI, 0.14–0.81), with no significant differences observed in other inflammatory disease subgroups. Conclusions Females with CID undergoing TAVI had a lower risk of AIS and comparable in-hospital mortality to males, particularly in those with inflammatory arthritis.