Impact of renin-angiotensin system inhibitors on outcomes after surgical or transcatheter aortic valve replacement. A meta-analysis

• Published in: Revista española de cardiología (English ed.) 2021-05, Vol.74 (5), p.421-426
• Main Authors: Amat-Santos, Ignacio J., Santos-Martínez, Sandra, Julca, Fabián, Catalá, Pablo, Rodríguez-Gabella, Tania, Redondo-Diéguez, Alfredo, Hinojosa, Williams, Veras, Carlos, Campo, Alberto, Serrador Frutos, Ana, Carrasco-Moraleja, Manuel, San Román, José A.
• Format: Article
• Language: English
• Subjects: Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Heart Valve Prosthesis Implantation; Humans; Inhibidores del sistema renina-angiotensina; RAS inhibitors; Renin-Angiotensin System; Risk Factors; TAVI; TAVR; Transcatheter Aortic Valve Replacement; Treatment Outcome
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2020.03.004

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). 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. 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