Associations between medical therapy after surgical aortic valve replacement for aortic stenosis and long-term mortality: a report from the SWEDEHEART registry

• Published in: European heart journal. Cardiovascular pharmacotherapy 2022-12, Vol.8 (8), p.837-846
• Main Authors: Baranowska, Julia, Törngren, Charlotta, Nielsen, Susanne J, Lindgren, Martin, Björklund, Erik, Ravn-Fischer, Annica, Skoglund, Kristofer, Jeppsson, Anders, Martinsson, Andreas
• Format: Article
• Language: English
• Subjects: Analysis; Angiotensin; Aortic stenosis; Aortic Valve - surgery; Aortic valve replacement; Aortic valve stenosis; Aortic Valve Stenosis - surgery; Cardiac and Cardiovascular Systems; Cardiology; Cardiovascular disease; Clinical outcomes; Comorbidity; Health aspects; Heart failure; Heart surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Implants, Artificial; Kardiologi; Medical therapy; Mortality; Original; Prosthesis; Registries; Renin–angiotensin inhibitors; Statins; Sweden; Trade and professional associations; Treatment Outcome; β-Blockers
• ISSN: 2055-6837; 2055-6845; 2055-6845
• DOI: 10.1093/ehjcvp/pvac034

Abstract Aims The association between the use of statins, renin–angiotensin system (RAS) inhibitors, and/or β-blockers and long-term mortality in patients with aortic stenosis (AS) who underwent surgical aortic valve replacement (SAVR) is unknown. Methods and results All patients with AS who underwent isolated first-time SAVR in Sweden from 2006 to 2017 and survived 6 months after discharge were included. Individual patient data from four mandatory nationwide registries were merged. Cox proportional hazards models, with time-updated data on medication status and adjusted for age, sex, comorbidities, type of prosthesis, and year of surgery, were used to investigate associations between dispensed statins, RAS inhibitors, and β-blockers and all-cause mortality. In total, 9553 patients were included, and the median follow-up time was 4.9 years (range 0–11); 1738 patients (18.2%) died during follow-up. Statins were dispensed to 49.1% and 49.0% of the patients within 6 months of discharge from the hospital and after 10 years, respectively. Corresponding figures were 51.4% and 53.9% for RAS inhibitors and 79.3% and 60.7% for β-blockers. Ongoing treatment was associated with lower mortality risk for statins {adjusted hazard ratio (aHR) 0.67 [95% confidence interval (95% CI) 0.60–0.74]; P