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Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: a cohort study
Citation
Goel, SS and Aksoy, O and Gupta, S and Houghtaling, PL and Tuzcu, EM and Marwick, TH and Mihaljevic, T and Svensson, L and Blackstone, EH and Griffin, BP and Stewart, WJ and Barzilai, B and Menon, V and Kapadia, SR, Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: a cohort study, Annals of Internal Medicine, 161, (10) pp. 699-710. ISSN 0003-4819 (2014) [Refereed Article]
Copyright Statement
Copyright 2014 American College of Physicians
DOI: doi:10.7326/M13-1505
Abstract
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 propensity-matched 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.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Research Division: | Biomedical and Clinical Sciences |
| Research Group: | Cardiovascular medicine and haematology |
| Research Field: | Cardiology (incl. cardiovascular diseases) |
| Objective Division: | Health |
| Objective Group: | Clinical health |
| Objective Field: | Clinical health not elsewhere classified |
| UTAS Author: | Marwick, TH (Professor Tom Marwick) |
| ID Code: | 100395 |
| Year Published: | 2014 |
| Web of Science® Times Cited: | 26 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2015-05-14 |
| Last Modified: | 2017-11-01 |
| Downloads: | 0 |
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