Abstract Body: Background: Transcatheter aortic valve replacement (TAVR) is increasingly performed for severe aortic stenosis, and coronary artery disease (CAD) is common among patients undergoing evaluation for the procedure. Evaluating the impact of CAD on mortality and periprocedural outcomes is essential for risk stratification and management in this population.

Hypothesis: We assessed the hypothesis that the presence of coronary artery disease is associated with lower in-hospital mortality and fewer periprocedural complications among patients undergoing TAVR.

Methods: Patients admitted for TAVR were identified using the 2021 National Inpatient Sample. Admissions were stratified based on the presence of CAD. Univariate analyses were performed, followed by multivariable logistic and linear regression models to evaluate associations with in-hospital outcomes. Analyses were adjusted for demographic, clinical, and hospital-level covariates, including comorbidity burden assessed using the Charlson Comorbidity Index. Statistical significance was defined as a two-tailed p-value <0.05.

Results: In 2021, an estimated 86,454 adults underwent TAVR during hospitalization. Of these, 58,044 were documented to have a secondary diagnosis of CAD (67.1%). The mean age in the CAD group was 78.4 years. Most patients in this group were male (63.5%), White (88.2%), had Medicare insurance (88.9%), and were treated at urban teaching hospitals (67.8%). After multivariable adjustment for age, sex, insurance status, income level, Charlson Comorbidity Index, hospital location, and teaching status, CAD in patients undergoing TAVR was independently associated with lower in-hospital mortality (aOR 0.58, 95% CI 0.42 – 0.80, p < 0.001). This population also had decreased odds of vasopressor use (aOR 0.74, 95% CI 0.59-0.94, p < 0.001) and mechanical ventilation (aOR 0.54, 95% CI 0.42-0.70, p = 0.00).

Conclusion: In a national cohort of patients undergoing TAVR, CAD was highly prevalent yet associated with lower in-hospital mortality and fewer periprocedural complications. These findings suggest that CAD does not confer excess short-term risk in contemporary TAVR practice and may reflect differences in patient selection, perioperative management, or clinical surveillance. Further studies are warranted to clarify the mechanisms underlying these associations.