Sex Differences in Acute Ischemic Stroke After Transcatheter Aortic Valve Implantation in Chronic Inflammatory Disease: National Inpatient Study

Chronic inflammatory diseases (CID) increase the risk of aortic stenosis, but sex-specific outcomes after transcatheter aortic valve implantation (TAVI) in this population are unclear. Using the US National Inpatient Sample (2016–2021), we identified adults with CID undergoing TAVI and classified CID as inflammatory arthritis, systemic autoimmune, or organ-specific inflammatory disease. Primary outcomes were acute ischemic stroke (AIS) and in-hospital mortality. Multivariable logistic regression adjusted for demographics and comorbidities, with stratified analyses by CID subtype. Among 15,825 patients, 9,695 (61.3%) were female. Compared with males, females were less often White (87.2% vs 92.1%) and had fewer cardiovascular risk factors, including dyslipidemia (65.5% vs 75.0%), diabetes (28.9% vs 34.3%), prior coronary artery bypass grafting (4.3% vs 15.7%), and smoking (29.6% vs 51.2%). After adjustment, females had a significantly lower risk of AIS (1.3% vs 2.4%; adjusted odds ratio [aOR] 0.50, 95% confidence interval [CI] 0.29–0.88), while in-hospital mortality was similar (1.0% vs 0.7%; aOR 0.96, 95% CI 0.41–2.22). The lower AIS risk in females was most pronounced in the inflammatory arthritis subgroup (aOR 0.34, 95% CI 0.14–0.81). Females with CID undergoing TAVI have lower AIS risk but comparable in-hospital mortality versus males, particularly in inflammatory arthritis patients.