Tirzepatide Linked to Fewer Cardiac Events After PCI and TAVR: Three Propensity-Matched Studies at SCAI 2026 and AACE 2026

What Happened

Two propensity-matched observational studies presented at the Society for Cardiovascular Angiography and Interventions (SCAI) Scientific Sessions on April 23 and 24, 2026 reported that tirzepatide use was associated with fewer deaths and fewer major adverse cardiovascular events in two of the highest-risk populations in interventional cardiology — patients undergoing percutaneous coronary intervention and patients undergoing transcatheter aortic valve replacement. Together with a third study presented April 23 at the American Association of Clinical Endocrinology meeting in obese patients with hypothyroidism, the data converge on a now-familiar pattern: tirzepatide outperforms older GLP-1 agonists, and outperforms no GLP-1 therapy at all, on hard cardiovascular endpoints in the messy populations clinicians actually treat.

None of these are randomized trials. All three are retrospective database analyses, with the limits that come with that design. They land, however, against a backdrop of randomized evidence — SUMMIT, SURPASS-CVOT, SELECT — that already places GLP-1 and dual GIP/GLP-1 agonism inside the cardiometabolic standard of care. The new SCAI data extend that argument into the procedural-cardiology population for the first time.

The Numbers That Matter

• SCAI 2026, PCI study (Varma et al., April 23): 1,281 propensity-matched pairs of adults with type 2 diabetes treated at the time of PCI. Tirzepatide use was associated with lower MACE at one month and one year, and lower one-year risks of acute myocardial infarction, heart failure exacerbation, and death versus dulaglutide.
• SCAI 2026, TAVR study (Mortada et al., April 24): 398 propensity-matched pairs of adults with obesity who underwent TAVR between 2020 and 2025. One-year event-free survival was 84.1% with tirzepatide vs 77.7% without, with fewer hospitalizations for acute heart failure and fewer MACE.
• AACE 2026 (Cecil et al., April 23): 42,940 propensity-matched pairs of adults with obesity and hypothyroidism. Five-year all-cause mortality was 0.7% with tirzepatide vs 1.2% with semaglutide, with statistically lower rates of heart failure (1.7% vs 2.2%), new-onset hypertension (6.1% vs 7.7%), incident type 2 diabetes (3.9% vs 4.8%), cerebrovascular disease, chronic kidney disease, and pulmonary embolism.
• All three analyses used the TriNetX Global Collaborative Network. All three were retrospective, not randomized.
• Effect sizes for the SCAI presentations were reported as relative risk reductions in the conference abstracts; full hazard ratios and confidence intervals will appear in the published manuscripts.

What Was Actually Presented

SCAI's spring meeting is the procedural cardiology field's main forum, and the abstracts that landed there last week are not surprising in direction so much as they are surprising in setting. The randomized evidence base for tirzepatide's cardiometabolic effects is built on outpatient populations — SURMOUNT for obesity, SURPASS for type 2 diabetes, SUMMIT for heart failure with preserved ejection fraction. The Varma and Mortada analyses asked a narrower question: does the signal hold in patients who are sick enough to be on a cath table?

The PCI analysis pulled adults with type 2 diabetes from the TriNetX network who underwent percutaneous coronary intervention while taking either tirzepatide or dulaglutide, the long-acting GLP-1 receptor agonist Eli Lilly markets as Trulicity. After 1:1 propensity matching on baseline cardiovascular risk factors, the tirzepatide arm had lower rates of MACE at one month and at one year, with one-year reductions also seen in acute myocardial infarction, heart failure decompensation, and all-cause death. Dulaglutide is not an idle comparator. Its REWIND trial in 2019 was one of the early primary-prevention cardiovascular outcomes trials in the GLP-1 class, showing a 12% relative risk reduction in MACE in adults with type 2 diabetes. Beating it on observational data in a sicker population is a meaningful step for the dual agonist.

The TAVR analysis was tighter and arguably more striking. Adults with obesity who underwent transcatheter aortic valve replacement between 2020 and 2025 were sorted by whether they were on tirzepatide. Propensity matching produced 398 patients in each arm. One-year event-free survival was 84.1% in the tirzepatide group versus 77.7% in the comparator — a 6.4-percentage-point absolute difference in a population in which most clinicians would not have predicted a weight-loss drug to materially move the survival curve. Acute heart failure hospitalizations and MACE were also lower.

The AACE study sat alongside these as a kind of mechanistic bridge. Cecil and colleagues built the largest of the three cohorts — nearly 86,000 patients total — in obese adults with hypothyroidism, comparing tirzepatide initiation against semaglutide initiation. Five-year all-cause mortality was almost halved in absolute terms. Heart failure, hypertension, incident diabetes, stroke, kidney disease, and pulmonary embolism all came in lower with tirzepatide. Myocardial infarction and osteoporosis did not move.

Why It Matters

Look at this from a hospitalist's bench. A 67-year-old patient with obesity and severe aortic stenosis is being scheduled for TAVR. The patient is also on tirzepatide for weight management. A year ago, the conversation about that prescription was about gastrointestinal side effects, anesthesia considerations around delayed gastric emptying, and whether to hold doses around the procedure. Today, that prescription is plausibly a prognosis-modifying medication. The pre-op conversation changes.

That is what these conference abstracts move. They do not establish that tirzepatide should be initiated peri-procedurally. They do not show that adding tirzepatide to PCI care improves outcomes — both studies looked at patients already on therapy. They do begin to suggest that procedural cardiology populations are not exempt from the cardiometabolic story the drug is rewriting outside the cath lab. SUMMIT already established that tirzepatide in HFpEF with obesity reduces the risk of cardiovascular death or worsening heart failure events. SURPASS-CVOT established noninferiority and signals of superiority versus dulaglutide for hard cardiovascular endpoints. The new data fold in patients in the immediate aftermath of revascularization or valve replacement.

From the payer side, the calculation is the same as the one set down by the Apr 21 Journal of Medical Economics paper on tirzepatide versus semaglutide cost-effectiveness: list prices are similar; downstream cardiovascular events are not. Each prevented heart failure hospitalization in a TAVR survivor is a five-figure saved cost; each prevented re-MI in a PCI patient, similar. The economics flow the same direction the clinical signal does.

How The Data Were Built (And What That Means)

All three analyses lean on TriNetX, a research network that aggregates de-identified electronic health record data across U.S. and international health systems. TriNetX has become the workhorse of cardiovascular pharmacoepidemiology because it captures procedure codes, lab values, prescriptions, and outcomes at scale. It is not, however, a randomized trial.

Propensity matching tries to balance treatment groups on observable baseline characteristics — age, sex, BMI, comorbidities, prior medications. It cannot balance unobserved characteristics. Patients prescribed tirzepatide are different from patients prescribed dulaglutide for reasons that do not all live in the chart. Insurance access, patient preference, prescriber familiarity, and patient adherence to weight-loss therapy are all entangled. Sicker patients who have struggled with multiple drugs and multiple referrals may be the ones who end up on a newer agent — or, just as plausibly, the healthier, more activated patients are the ones who push to switch. The analyst cannot tell which.

This is the central reason these three abstracts will be received as hypothesis-generating rather than practice-changing. SUMMIT, SURPASS-CVOT, and SELECT are randomized; they answer the question of cause and effect within their enrollment criteria. The TriNetX studies are descriptive evidence about what happens to real patients in real systems and they are valuable precisely because they cover patients randomized trials usually do not enroll. They also cannot tell a clinician whether starting tirzepatide changes outcomes, only that being on tirzepatide is associated with better ones.

Caveats Worth Naming

Several constraints sit on top of the underlying database limitation. The PCI study's comparator is dulaglutide, not no GLP-1 therapy — so the result reads as tirzepatide versus an active comparator with established cardiovascular benefit, which makes it more, not less, demanding. The TAVR study's comparator is no tirzepatide, not no GLP-1, so some of the comparator arm is on other GLP-1 agents and the contrast is muddier. The AACE study's hypothyroidism enrichment captures one population — obesity plus hypothyroidism — in which TSH changes and levothyroxine dosing were not captured by the database, leaving room for residual confounding through thyroid status alone.

Sample sizes in the SCAI analyses are small enough that point estimates will move in any further reanalysis. The 398-pair TAVR cohort is precisely the size at which a single confounder can flip an event-free survival curve. The PCI cohort at 1,281 pairs is more stable, and its results align with the direction set by SURPASS-CVOT, which is the benchmark for how a dual GIP/GLP-1 agonist behaves against an active GLP-1 comparator.

Funding disclosures for the SCAI presentations were not stated in the conference materials accessed for this report. Readers should consult the full abstracts when published in JACC: Cardiovascular Interventions or Catheterization and Cardiovascular Interventions, where SCAI sessions data typically lands within several months.

How It Fits With This Week

The SCAI data arrived in the same week as the FDA's procedural Category 2 removal of 12 compounded peptides — an unrelated regulatory event that has dominated peptide-policy headlines for the last fortnight. None of the 12 peptides on the FDA's compounding docket are GLP-1-class; the agency's PCAC docket closes July 22 and concerns BPC-157, KPV, TB-500, MOTs-C, DSIP, Semax, and Epitalon. The SCAI presentations sit on the opposite end of the peptide regulatory map — FDA-approved branded products with phase-3 cardiovascular evidence, deepening that evidence with procedural-population data.

The two stories are connected only by the broader trajectory of peptide therapeutics. On the regulated end, evidence accumulates and indications widen. On the unregulated end, access is being relitigated. PeptideKnow covers both because clinicians, payers, and patients have to read both.

Related Peptides and Context on PeptideKnow

Profiles for the four GLP-1 and dual-agonist compounds that show up in this week's data:

For broader context, see PeptideKnow's cardiovascular peptides and weight-loss and metabolic indices.

Frequently Asked Questions

Should patients on tirzepatide stop the drug before PCI or TAVR?

The SCAI data do not change peri-procedural management directly, and the question of whether to hold GLP-1 or dual agonist therapy before procedures requiring sedation has been driven by anesthesia concerns about delayed gastric emptying rather than cardiovascular outcomes. Specific peri-operative guidance from the American Society of Anesthesiologists is the relevant reference, and it has shifted as evidence has accumulated. The new SCAI data argue, if anything, that interrupting therapy unnecessarily is worth avoiding when a safe periprocedural plan can be made.

Did the studies show that starting tirzepatide improves outcomes after PCI or TAVR?

No. Both SCAI analyses compared patients who were already on tirzepatide at the time of their procedure to matched controls. They did not test initiation. Whether starting tirzepatide after revascularization or valve replacement improves outcomes would require a different trial design.

How does this relate to SURPASS-CVOT and SUMMIT?

SURPASS-CVOT was a randomized cardiovascular outcomes trial of tirzepatide versus dulaglutide in adults with type 2 diabetes and established cardiovascular disease; results published in 2026 showed a lower incidence of a six-component composite cardiovascular and kidney endpoint with tirzepatide. SUMMIT was a randomized trial of tirzepatide versus placebo in heart failure with preserved ejection fraction and obesity, showing a 38% relative reduction in cardiovascular death or worsening heart failure. The new SCAI data extend that randomized evidence into procedural cardiology populations using observational methods.

Are these the same as the cost-effectiveness paper PeptideKnow covered yesterday?

No, they are independent. The April 21 Journal of Medical Economics paper modeled lifetime costs and quality-adjusted life-years for tirzepatide versus semaglutide in adults with obesity but without diabetes, anchored on the SURMOUNT-5 head-to-head trial. The SCAI presentations are observational analyses in interventional cardiology populations. Both, however, point in the same direction on hard outcomes.

Where will these data be published?

SCAI Scientific Sessions abstracts typically appear in JACC: Cardiovascular Interventions or Catheterization and Cardiovascular Interventions; the AACE 2026 hypothyroidism analysis is summarized in the Cleveland Clinic Journal of Medicine's conference page and will appear in the meeting proceedings. PeptideKnow will update this article with full citations as they become available.

Does dulaglutide have its own profile on PeptideKnow?

Yes. Dulaglutide's full profile, including REWIND trial data, dosing, and safety, was added alongside this article.

Sources

• Varma R. Real-World Cardiovascular Outcomes of Tirzepatide Versus Dulaglutide After Percutaneous Coronary Intervention. SCAI Scientific Sessions 2026, presented April 23, 2026. Coverage: Epocrates summary, April 24, 2026.
• Mortada I. Association of Tirzepatide Use with Clinical Outcomes After TAVR in Obese Patients: A Propensity-Matched Real-World Study. SCAI Scientific Sessions 2026, presented April 24, 2026.
• Cecil A, Essien E, Agyekum A, Amoako G. Tirzepatide use linked to lower mortality, improved cardiometabolic outcomes vs semaglutide in obese patients with hypothyroidism. AACE 2026 Annual Scientific & Clinical Congress, presented April 23, 2026. Cleveland Clinic Journal of Medicine: conference summary.
• Nicholls SJ, Bhatt DL, Buse JB, et al. Cardiorenal Outcomes With Tirzepatide Compared With Dulaglutide in Patients With Diabetes and Cardiovascular Disease: A Post Hoc Analysis of the SURPASS-CVOT Randomized Clinical Trial. JAMA Cardiol. 2026 Mar 28:e260767. doi:10.1001/jamacardio.2026.0767. PubMed PMID 41903177.
• Packer M, Zile MR, Kramer CM, et al. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity (SUMMIT). N Engl J Med. 2025;392:427-437. doi:10.1056/NEJMoa2410027.
• Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019;394(10193):121-130. PubMed PMID 31189511.

Published April 27, 2026. PeptideKnow Editorial.