Publish in this journal
Journal Information
Share
Share
Download PDF
More article options
ePub
Visits
Not available
Original article
DOI: 10.1016/j.rec.2020.03.004
Available online 11 May 2020
Impact of renin-angiotensin system inhibitors on outcomes after surgical or transcatheter aortic valve replacement. A meta-analysis
Impacto de los inhibidores del sistema renina-angiotensina en el pronóstico tras recambio valvular aórtico quirúrgico o percutáneo. Metanálisis
Visits
...
Ignacio J. Amat-Santosa,b,
Corresponding author
ijamat@gmail.com

Corresponding author at: Corresponding author: Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47005 Valladolid, Spain.
, Sandra Santos-Martíneza, Fabián Julcaa, Pablo Cataláa, Tania Rodríguez-Gabellaa, Alfredo Redondo-Diégueza, Williams Hinojosaa, Carlos Verasa, Alberto Campoa, Ana Serrador Frutosa, Manuel Carrasco-Moralejab, José A. San Romána,b
a Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
b Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
This item has received
...
Visits
(Daily data update)
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (4)
Show moreShow less
Tables (1)
Table 1. Baseline clinical characteristics reported in each of the studies included in this meta-analysis
Additional material (1)
Abstract
Introduction and objectives

To determine whether renin-angiotensin system inhibitor (RASi) prescription is associated with better outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR).

Methods

All comparative studies of RASi vs no RASi prescription in patients undergoing TAVI/SAVR were gathered from PubMed, Web of Science, and Google Scholar through August, 2019. We extracted hazard ratios (HRs) with their confidence intervals (CIs) for mortality from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random effects model.

Results

We identified 6 eligible studies with a total of 21 390 patients (TAVI: 17 846; SAVR: 3544) and included them in the present meta-analysis. The 6 studies were observational comparative studies (including 3 propensity score matched and 3 cohort studies) of RASi vs no RASi prescription. The analysis demonstrated that RASi prescription was associated with significantly lower mortality in the whole group of patients undergoing aortic valve intervention (HR, 0.64; 95%CI, 0.47-0.88; P <.001). However, subgroup analysis suggested differences according to the selected therapy, with TAVI showing better mortality rates in the RASi group (HR, 0.67; 95%CI, 0.49-0.93) but not in the SAVR group (HR, 0.61; 95%CI, 0.29-1.30). No funnel plot asymmetry was identified, suggesting minimum publication bias. Sensitivity analyses sequentially eliminating dissimilar studies did not substantially alter the primary result favoring RASI prescription.

Conclusions

These findings suggest a mortality benefit of RASi in patients with AS treated with aortic valve replacement that might be particularly relevant following TAVI. Future randomized studies are warranted to confirm this relevant finding.

Keywords:
TAVI
TAVR
RAS inhibitors
Abbreviations:
RASi
SAVR
TAVI
Resumen
Introducción y objetivos

Determinar si la prescripción de inhibidores del sistema renina-angiotensina (iSRA) se asocia a mejores resultados tras implante percutáneo de válvula aórtica (TAVI) o recambio valvular aórtico quirúrgico (RVAQ).

Métodos

Se seleccionaron de PubMed, Web of Science, y Google Scholar hasta agosto de 2019 estudios comparativos de iSRA vs no-iSRA en pacientes sometidos a TAVI/RVAQ. Se extrajeron las hazard ratios (HR) con sus intervalos de confianza para mortalidad de cada estudio y estimadores específicos en el modelo de efectos aleatorios.

Resultados

Se incluyeron 6 estudios con un total de 21.390 pacientes (TAVI: 17.846, RVAQ: 3.544). Los 6 fueron estudios comparativos (3 análisis de propensión y 3 de cohortes) comparando iSRA vs no-iSRA. Se demostró que la prescripción de iSRA se asocia con una mortalidad significativamente menor en pacientes sometidos a intervención valvular aórtica (HR=0,64; IC95%, 0,47-0,88; p <0,001). Sin embargo, el análisis por subgrupos sugirió diferencias en función de la terapia seleccionada, con menor mortalidad en los sometidos a TAVI tratados con iSRA (HR=0,67; IC95%, 0,49-0,93) pero no en los tratados con RVAQ (HR=0,61; IC95%, 0,29-1,30). No se identificó asimetría en el análisis funnel plot, sugiriendo bajo riesgo de sesgo de publicación. El análisis de sensibilidad eliminando sucesivamente diferentes estudios no alteró de forma substancial el resultado.

Conclusiones

Estos resultados sugieren reducción de la mortalidad con la prescripción de iSRA en pacientes con estenosis aórtica sometidos a recambio valvular aórtico, en particular tras TAVI. Futuros estudios aleatorizados deberán confirmar o refutar este relevante hallazgo.

Palabras clave:
TAVI
TAVR
Inhibidores del sistema renina-angiotensina

Article

These are the options to access the full texts of the publication Revista Española de Cardiología (English Edition)
Member
Members of SEC
Use the Society's website login and password here
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Revista Española de Cardiología (English Edition)

Comprar
Comprar acceso al artículo

Comprando el artículo el PDF del mismo podrá ser descargado

Precio 22,50 €

Comprar ahora
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.