AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Glucagon-Like Peptide- 1 Receptor Agonists Before Transcatheter Aortic Valve Replacement: A Propensity-Matched Analysis of Mortality and Cardiorenal Protection
By Azhar MJ, Singleton N, Agha MA et al.
Background: Transcatheter Aortic Valve Replacement (TAVR) is a well-established intervention for severe aortic stenosis. However, cardiovascular and renal complications following the procedure are still prevalent and are linked to poorer prognoses. Although GLP-1 receptor agonists have shown cardiometabolic advantages in atherosclerotic disease, their effect on patients undergoing TAVR remains uncertain. This study investigates the relationship between pre-procedural use of GLP-1 receptor agonists and subsequent cardiovascular and renal outcomes post-TAVR. Hypothesis: Pre-procedural GLP-1 RA use in TAVR patients is associated with reduced cardiovascular and renal complications. Methods: A retrospective cohort study was performed utilizing the TriNetX Global Collaborative Network. Adult individuals (aged 18 years and older) undergoing Transcatheter Aortic Valve Replacement(TAVR) were identified through CPT and ICD-10-PCS codes. Participants were stratified based on exposure to Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA), including liraglutide, semaglutide, dulaglutide, exenatide, and lixisenatide, within a 12-month period preceding the procedure. Propensity score matching at a ratio of 1:1, considering demographics, comorbidities and baseline medications, resulted in two cohorts of 2,550 patients each. The study evaluated outcomes such as myocardial infarction, heart failure, arrhythmias, all-cause mortality, stroke, and acute kidney injury, with exclusion of patients with prior history of these outcomes. The analytical methods employed included risk difference, risk ratio, Kaplan-Meier survival analysis, Cox proportional hazards models, and comparison of event frequencies. Results: GLP-1 RA use was associated with lower all-cause mortality (17.0% vs 27.9%; RR 0.61; p=0.001; ARR 10.9%), myocardial infarction (8.2% vs 11.9%; RR 0.69; p=0.001), and acute kidney injury (17.9% vs 22.9%; RR 0.78; p=0.001). No significant differences were observed in heart failure (30.3% vs 33.1%; p=0.293), arrhythmias (31.4% vs34.8%; p=0.110), or stroke (7.9% vs 9.4%; p=0.072). Kaplan-Meier analyses showed no significant time-to-event differences for most outcomes, with evidence of non-proportional hazards for mortality and AKI. Mean follow-up was shorter in the GLP-1 RA group (795 vs 1,239 days), which may have influenced time-dependent analyses. Conclusion: Pre-procedural GLP-1 RA use was associated with decreased risks of myocardial infarction, acute kidney injury, and all-cause mortality following TAVR. Although residual confounding may exist, these findings indicate potential benefits and underscore the need for prospective studies to establish causality and evaluate clinical utility.