Association of Tirzepatide Use With Clinical Outcomes After TAVR in Obese Patients: A Propensity Score–Matched Real-World Study

Background Patients with obesity undergoing transcatheter aortic valve replacement (TAVR) remain at elevated risk for recurrent heart failure (HF) and cardiorenal events. Tirzepatide produces substantial weight loss and metabolic improvement, but its impact in post-TAVR populations is unknown. Methods We performed a retrospective study using the TriNetX Global Collaborative Network. Adults with obesity who underwent TAVR between January 1, 2020, and January 1, 2025, were included. Patients initiating tirzepatide after TAVR were compared with patients not receiving tirzepatide. The primary outcome included HF events, while secondary outcomes were acute kidney injury (AKI), acute myocardial infarction (AMI), and ischemic stroke (IS). Fall events were prespecified as a falsification end point. Associations were evaluated using hazard ratios (HRs) with 95% CIs. Results Propensity score matching (1:1) balanced demographic characteristics, comorbidities, medications, and laboratory characteristics, yielding 421 patients in each cohort. Over 1 year of follow-up, tirzepatide use was associated with a significantly lower hazard of HF (HR, 0.68; 95% CI, 0.56-0.83) and AKI (HR, 0.63; 95% CI, 0.43-0.93). Associations with AMI (HR, 0.81; 95% CI, 0.48-1.37) and IS (HR, 0.726; 95% CI, 0.45-1.17) were not statistically significant. The falsification end point was likewise similar between groups (HR, 0.82; 95% CI, 0.47-1.43). Conclusions Among patients with obesity undergoing TAVR, tirzepatide use was associated with a lower hazard of HF and AKI within 1 year. No significant association was observed for AMI or IS. These findings suggest potential cardiorenal benefits of tirzepatide in high-risk structural heart populations and warrant prospective evaluation.