Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: A cohort study

Sachin S. Goel, Olcay Aksoy, Supriya Gupta, Penny L. Houghtaling, E. Murat Tuzcu, Thomas Marwick, Tomislav Mihaljevic, Lars Svensson, Eugene H. Blackstone, Brian P. Griffin, William J. Stewart, Benico Barzilai, Venu Menon, Samir R. Kapadia

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Background: Data are lacking on the effect of renin-angiotensin system (RAS) blockade therapy with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers after surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS).

Objective: To investigate the association between RAS blockade therapy and outcomes after SAVR for severe AS.

Design: Retrospective study.

Setting: Single tertiary referral care center. Patients: Patients who were prescribed angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers after SAVR for severe AS between 1991 and 2010 who had at least 2 refills 90 days apart and at least a 6-month follow-up constituted the RAS blockade group (n = 741). Patients who did not receive these prescriptions were in the untreated group (n = 1011). Unadjusted and propensity-matched analyses (594 matched pairs of treated and untreated patients) were performed.

Measurements: The primary outcome was survival rates after SAVR. Secondary end points were changes in left ventricular mass index, left ventricular ejection fraction, and left atrial size.

Results: Overall unadjusted estimated survival rates at 1, 5, and 10 years were significantly greater in the RAS blockade group than in the non-RAS blockade group (99%, 90%, and 60% vs. 99%, 81%, and 53%, respectively; P < 0.001). Among propensitymatched patients, estimated survival rates at 1, 5, and 10 years remained significantly greater in the RAS blockade group than in the non-RAS blockade group (99%, 90%, and 71% vs. 96%, 78%, and 49%, respectively; P < 0.001). For the matched cohorts, the groups did not significantly differ in the change in left ventricular mass index (P = 0.37), left ventricular ejection fraction (P = 0.67), or left atrial size (P = 0.43) after SAVR on echocardiographic analysis. Limitation: Retrospective, single-center analysis.

Conclusion: Renin-angiotensin system blockade therapy is associated with increased survival rates in patients after SAVR for severe AS. A randomized trial of RAS blockade therapy after SAVR should be considered.

Original languageEnglish (US)
Pages (from-to)699-710
Number of pages12
JournalAnnals of Internal Medicine
Volume161
Issue number10
DOIs
StatePublished - Nov 18 2014

ASJC Scopus subject areas

  • Internal Medicine

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