Renin-Angiotensin System Inhibition and Cardiac Damage in Patients Undergoing Transcatheter Aortic Valve Replacement.
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BORIS DOI
Publisher DOI
PubMed ID
39067618
Description
BACKGROUND
The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and may be impacted by the extent of extra-valvular cardiac damage. We aimed to investigate the prognostic effect of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified by the extent of extra-valvular cardiac damage.
METHODS
In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into five stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge.
RESULTS
Among 2,247 eligible patients undergoing TAVR between August 2007 and June 2021, 1,634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as Stage 0, 276 (12.3%) as Stage 1, 889 (39.6%) as Stage 2, 489 (21.8%) as Stage 3, and 510 (22.7%) as Stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (HRadjusted 0.59, 95% CI 0.45-0.77). The protective effect was accentuated among patients with cardiac stage 3 and 4 (HRadjusted 0.54, 95% CI 0.32-0.92 and HRadjusted 0.58, 95% CI 0.36-0.92, respectively), but not statistically significant in stages 2 (HRadjusted 0.70, 95% CI 0.43-1.14).
CONCLUSIONS
In patients undergoing TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage.
The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and may be impacted by the extent of extra-valvular cardiac damage. We aimed to investigate the prognostic effect of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified by the extent of extra-valvular cardiac damage.
METHODS
In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into five stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge.
RESULTS
Among 2,247 eligible patients undergoing TAVR between August 2007 and June 2021, 1,634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as Stage 0, 276 (12.3%) as Stage 1, 889 (39.6%) as Stage 2, 489 (21.8%) as Stage 3, and 510 (22.7%) as Stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (HRadjusted 0.59, 95% CI 0.45-0.77). The protective effect was accentuated among patients with cardiac stage 3 and 4 (HRadjusted 0.54, 95% CI 0.32-0.92 and HRadjusted 0.58, 95% CI 0.36-0.92, respectively), but not statistically significant in stages 2 (HRadjusted 0.70, 95% CI 0.43-1.14).
CONCLUSIONS
In patients undergoing TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage.
Date of Publication
2024-12
Publication Type
Article
Subject(s)
Keyword(s)
Aortic stenosis cardiac damage staging classification renin-angiotensin system inhibitors transcatheter aortic valve replacement
Language(s)
en
Contributor(s)
Nakase, Masaaki |
Additional Credits
Series
The Canadian journal of cardiology
Publisher
Elsevier
ISSN
1916-7075
Access(Rights)
open.access