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.
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。