TY - JOUR
T1 - Impact of renin-angiotensin systeminhibitors on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
T2 - An analysis of from the PARTNER 2 trial and registries
AU - Chen, Shmuel
AU - Redfors, Bjorn
AU - Nazif, Tamim
AU - Kirtane, Ajay
AU - Crowley, Aaron
AU - Ben-Yehuda, Ori
AU - Kapadia, Samir
AU - Finn, Matthew T.
AU - Goel, Sachin
AU - Lindman, Brian R.
AU - Alu, Maria C.
AU - Chau, Atherine H.
AU - Thourani, Vinod H.
AU - Vahl, Torsten P.
AU - Douglas, Pamela S.
AU - Kodali, Susheel K.
AU - Leon, Martin B.
N1 - Funding Information:
Conflict of interest: T.N. reports personal fees from Edwards Lifesciences, Boston Scientific, Medtronic, and BioTrace, outside the submitted work. A.K. reports grants from Medtronic, Abbott Vascular, Boston Scientific, Abiomed, CathWorks, Siemens, Philips, ReCor Medical, and Spectranetics, outside the submitted work. V.H.T. reports grants and personal fees from Edwards Lifesciences, outside the submitted work. T.P.V. reports institutional grants from Edwards Lifesciences and Medtronic, personal fees from JenaValve and Abbott, outside the submitted work. P.S.D. reports grants from Edwards Lifesciences, during the conduct of the study. S.K.K. reports grants from Edwards Lifesciences, during the conduct of the study; grants from Medtronic and Boston Scientific, grants and personal fees from Abbott Vascular, non-financial support from Dura Biotech and
Funding Information:
Thubrikar Aortic Valve, Inc.; personal fees from Claret Medical, Admedus, and Meril Lifesciences, and other from Biotrace Medical, outside the submitted work. M.B.L. reports institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific, outside the submitted work. All other authors report that they have nothing to disclose.
Publisher Copyright:
© The Author(s) 2019.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: [email protected].
PY - 2020/2/21
Y1 - 2020/2/21
N2 - AIMS: Left ventricular pressure overload is associated with activation of the cardiac renin-angiotensin system, which may contribute to myocardial fibrosis and worse clinical outcomes. We sought to assess the association between treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) at baseline and clinical outcomes in patients with symptomatic, severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) in the PARTNER 2 trial and registries.METHODS AND RESULTS: A total of 3979 intermediate, high, or prohibitive risk patients who underwent TAVR in the PARTNER 2 trial and registries (excluding the valve in valve registry) were included in the study. Clinical outcomes at 2 years were compared according to baseline ACEI/ARB treatment status using Kaplan-Meier event rates and study-stratified multivariable Cox proportional hazards regression models. Sensitivity analysis was conducted using propensity score matching. Of 3979 patients who were included in the current analysis, 1736 (43.6%) were treated and 2243 (56.4%) were not treated with ACEI/ARB at baseline. Treatment with ACEI/ARB was associated with lower 2-year all-cause mortality (18.6% vs. 27.5%, P < 0.0001), cardiovascular mortality (12.3% vs. 17.9%, P < 0.0001), and non-cardiovascular mortality (7.2% vs. 11.7%, P < 0.0001). Angiotensin-converting enzyme inhibitor/ARB treatment at baseline remained independently associated with a lower hazard of 2-year all-cause and cardiovascular mortality after multivariable adjustment, and propensity score matching.CONCLUSION: In a large cohort of patients with severe symptomatic AS from the PARTNER 2 trial and registries, ACEI/ARB treatment at baseline was independently associated with a lower risk of 2-year all-cause and cardiovascular mortality.
AB - AIMS: Left ventricular pressure overload is associated with activation of the cardiac renin-angiotensin system, which may contribute to myocardial fibrosis and worse clinical outcomes. We sought to assess the association between treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) at baseline and clinical outcomes in patients with symptomatic, severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) in the PARTNER 2 trial and registries.METHODS AND RESULTS: A total of 3979 intermediate, high, or prohibitive risk patients who underwent TAVR in the PARTNER 2 trial and registries (excluding the valve in valve registry) were included in the study. Clinical outcomes at 2 years were compared according to baseline ACEI/ARB treatment status using Kaplan-Meier event rates and study-stratified multivariable Cox proportional hazards regression models. Sensitivity analysis was conducted using propensity score matching. Of 3979 patients who were included in the current analysis, 1736 (43.6%) were treated and 2243 (56.4%) were not treated with ACEI/ARB at baseline. Treatment with ACEI/ARB was associated with lower 2-year all-cause mortality (18.6% vs. 27.5%, P < 0.0001), cardiovascular mortality (12.3% vs. 17.9%, P < 0.0001), and non-cardiovascular mortality (7.2% vs. 11.7%, P < 0.0001). Angiotensin-converting enzyme inhibitor/ARB treatment at baseline remained independently associated with a lower hazard of 2-year all-cause and cardiovascular mortality after multivariable adjustment, and propensity score matching.CONCLUSION: In a large cohort of patients with severe symptomatic AS from the PARTNER 2 trial and registries, ACEI/ARB treatment at baseline was independently associated with a lower risk of 2-year all-cause and cardiovascular mortality.
KW - ACEI/ARB
KW - Balloon-expandable valve
KW - PARTNER
KW - TAVI
KW - TAVR
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85080961316&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85080961316&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehz769
DO - 10.1093/eurheartj/ehz769
M3 - Article
C2 - 31711153
AN - SCOPUS:85080961316
SN - 0195-668X
VL - 41
SP - 943
EP - 954
JO - European heart journal
JF - European heart journal
IS - 8
ER -