Associated prognostic impact of opioid use before Transcatheter aortic valve implantation - A Danish nationwide cohort study.

Background: Opioid use is frequently reported as a baseline characteristic in transcatheter aortic valve implantation (TAVI) cohorts, yet its prognostic implications have not been examined. Aim: To examine the association between pre-procedural opioid use and post-TAVI outcomes. Methods: Using Danish nationwide registries, we identified patients undergoing TAVI between 2015 and 2022. Patients were categorized according to opioid use within one year before TAVI. We examined one-year all-cause mortality, cumulative days of hospitalization including the composite outcome of death or > 14 cumulative hospitalization days, and a potential opioid dose-response relationship. Adjusted relative risks were estimated using multivariable Cox and logistic regression. Results: We identified 6505 patients: 1265 (19.4%) with opioid use (48.9% male; median age 80 years) and 5240 (80.6%) without (59.4% male; median age 81 years). The two groups were comparable in cardiac comorbidities and malignancy but differed in musculoskeletal (back disorders: 45.9% vs 20.7%; arthropathies 65.3% vs 47.1%) and psychiatric conditions (antidepressants: 18.8% vs. 9.6%; anxiolytics/hypnotics: 23.7% vs. 12.4%). Baseline opioid use was associated with higher post-TAVI mortality (10.4% vs 6.9%; adjusted HR 1.35, 95% CI 1.11-1.66) and increased risk of the composite outcome (OR 1.47, 95% CI 1.25-1.72). A dose-response relationship was observed, with one-year mortality increasing from 7.0% in non-users to 8.8% in low-dose users and 12.1% in high-dose users. Conclusion: Baseline opioid use was associated with increased mortality and hospitalization burden in the year following TAVI, and this relationship was aggravated among high-dose users. The observed associations were most likely driven by the underlying condition of the opioid therapy.