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

doi:10.7326/M13-1505

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 journal › Article › peer-review

31 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 language	English (US)
Pages (from-to)	699-710
Number of pages	12
Journal	Annals of Internal Medicine
Volume	161
Issue number	10
DOIs	https://doi.org/10.7326/M13-1505
State	Published - Nov 18 2014

ASJC Scopus subject areas

Internal Medicine

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10.7326/M13-1505

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Goel, S. S., Aksoy, O., Gupta, S., Houghtaling, P. L., Tuzcu, E. M., Marwick, T., Mihaljevic, T., Svensson, L., Blackstone, E. H., Griffin, B. P., Stewart, W. J., Barzilai, B., Menon, V., & Kapadia, S. R. (2014). Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: A cohort study. Annals of Internal Medicine, 161(10), 699-710. https://doi.org/10.7326/M13-1505

Goel, SS, Aksoy, O, Gupta, S, Houghtaling, PL, Tuzcu, EM, Marwick, T, Mihaljevic, T, Svensson, L, Blackstone, EH, Griffin, BP, Stewart, WJ, Barzilai, B, Menon, V & Kapadia, SR 2014, 'Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: A cohort study', Annals of Internal Medicine, vol. 161, no. 10, pp. 699-710. https://doi.org/10.7326/M13-1505

@article{7f57cf8f5a454e01bc0a7cba60442545,

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

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.",

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

year = "2014",

month = nov,

day = "18",

doi = "10.7326/M13-1505",

language = "English (US)",

volume = "161",

pages = "699--710",

journal = "Annals of Internal Medicine",

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publisher = "American College of Physicians",

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T1 - Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis

T2 - A cohort study

AU - Goel, Sachin S.

AU - Aksoy, Olcay

AU - Gupta, Supriya

AU - Houghtaling, Penny L.

AU - Tuzcu, E. Murat

AU - Marwick, Thomas

AU - Mihaljevic, Tomislav

AU - Svensson, Lars

AU - Blackstone, Eugene H.

AU - Griffin, Brian P.

AU - Stewart, William J.

AU - Barzilai, Benico

AU - Menon, Venu

AU - Kapadia, Samir R.

PY - 2014/11/18

Y1 - 2014/11/18

N2 - 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.

AB - 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.

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

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