Abstract：
BACKGROUND: The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and might be affected by the extent of extravalvular cardiac damage. We aimed to investigate the prognostic association of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified according to the extent of extravalvular cardiac damage.
METHODS: In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into 5 stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge.
RESULTS: Among 2247 eligible patients who underwent TAVR between August 2007 and June 2021, 1634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as stage 0, 276 (12.3%) as stage 1, 889 (39.6%) as stage 2, 489 (21.8%) as stage 3, and 510 (22.7%) as stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (adjusted hazard ratio [HRadjusted], 0.59; 95% confidence interval [CI], 0.45-0.77). The protective association was accentuated among patients with cardiac stages 3 and 4 (HRadjusted, 0.54 [95% CI, 0.32-0.92]; and HRadjusted, 0.58 [95% CI, 0.36-0.92], respectively), but not statistically significant in for those with stage 2 (HRadjusted, 0.70; 95% CI, 0.43-1.14).
CONCLUSIONS: In patients who underwent TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage.
BACKGROUND: NCT01368250.
METHODS: In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into 5 stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge.
RESULTS: Among 2247 eligible patients who underwent TAVR between August 2007 and June 2021, 1634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as stage 0, 276 (12.3%) as stage 1, 889 (39.6%) as stage 2, 489 (21.8%) as stage 3, and 510 (22.7%) as stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (adjusted hazard ratio [HRadjusted], 0.59; 95% confidence interval [CI], 0.45-0.77). The protective association was accentuated among patients with cardiac stages 3 and 4 (HRadjusted, 0.54 [95% CI, 0.32-0.92]; and HRadjusted, 0.58 [95% CI, 0.36-0.92], respectively), but not statistically significant in for those with stage 2 (HRadjusted, 0.70; 95% CI, 0.43-1.14).
CONCLUSIONS: In patients who underwent TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage.
BACKGROUND: NCT01368250.
摘要：
背景：经导管主动脉瓣置换术（TAVR）后的最佳医学治疗策略尚未建立，并且可能受到瓣膜外心脏损伤程度的影响。我们旨在研究肾素-血管紧张素系统（RAS）抑制剂对TAVR患者的预后作用，该作用是根据瓣膜外心脏损害的程度进行分层的。
方法：在前瞻性TAVR注册中，我们对患者的基线心脏损害进行了回顾性评估,并根据既定标准将患者分为5个阶段(0~4).根据出院时的RAS抑制剂处方比较1年的临床结果。
结果：在2007年8月至2021年6月期间接受TAVR的2,247名符合条件的患者中，有1,634名（72.7％）在出院时服用了RAS抑制剂。83例患者（3.7％）分为0期，276例（12.3％）分为1期，889例（39.6％）分为2期，489例（21.8％）分为3期，510例（22.7％）分为4期。TAVR后RAS抑制剂处方与1年死亡率风险降低相关(HRadjusted0.59,95%CI0.45-0.77)。心脏3期和4期患者的保护作用更加明显（分别为HR调整0.54，95％CI0.32-0.92和HR调整0.58，95％CI0.36-0.92），但在第2阶段无统计学意义(HR校正0.70，95%CI0.43-1.14)。
结论：在接受TAVR的患者中，我们发现RAS抑制剂处方与整体人群的临床结局改善密切相关，并且在心脏损伤的各个阶段都没有异质性的迹象。
方法：在前瞻性TAVR注册中，我们对患者的基线心脏损害进行了回顾性评估,并根据既定标准将患者分为5个阶段(0~4).根据出院时的RAS抑制剂处方比较1年的临床结果。
结果：在2007年8月至2021年6月期间接受TAVR的2,247名符合条件的患者中，有1,634名（72.7％）在出院时服用了RAS抑制剂。83例患者（3.7％）分为0期，276例（12.3％）分为1期，889例（39.6％）分为2期，489例（21.8％）分为3期，510例（22.7％）分为4期。TAVR后RAS抑制剂处方与1年死亡率风险降低相关(HRadjusted0.59,95%CI0.45-0.77)。心脏3期和4期患者的保护作用更加明显（分别为HR调整0.54，95％CI0.32-0.92和HR调整0.58，95％CI0.36-0.92），但在第2阶段无统计学意义(HR校正0.70，95%CI0.43-1.14)。
结论：在接受TAVR的患者中，我们发现RAS抑制剂处方与整体人群的临床结局改善密切相关，并且在心脏损伤的各个阶段都没有异质性的迹象。
