Journal Article

Relation Between Renin-Angiotensin System Blockers and Survival Following Isolated Aortic Valve Replacement for Aortic Stenosis

Bégot, Emmanuelle, Guinot, Barthélémy, Le Guyader, Alexandre, Marsaud, Jean-Philippe, Aboyans, Victor, Mohty, Dania, Magne, Julien

2018

Overview

Renin-angiotensin system blockers (RASb) improve cardiac remodeling, but their clinical utility after surgical aortic valve replacement (SAVR) for aortic stenosis (AS) is unclear. We aimed to assess the impact of RASb on short- and long-term survival following isolated SAVR for severe AS. From January 2005 to January 2014, 508 consecutive patients had isolated SAVR for severe AS. Patients with RASb (n = 286; 53%) were more often female (p = 0.039), hypertensive (p < 0.0001), and diabetic (p = 0.004), with higher body mass index (p < 0.0001) and EuroSCORE II (p = 0.025), and lower mean aortic pressure gradient (p = 0.011). The 30-day mortality was similar in both groups (RASb: 3% vs no RASb: 5.8%, p = 0.13), but lower under angiotensin receptor blockers (ARB) than angiotensin-converting enzyme inhibitors (ACEi; 0.7% vs 5.6%, p = 0.017). Patients under RASb had a better 8-year survival than those without RASb (83 ± 3% vs 52 ± 5%, p < 0.0001), confirmed in a propensity score-matched pairs analysis (82 ± 4% vs 50 ± 7%, p < 0.0001). Regarding different types of RASb, patients under ARB had lower mortality than those under ACEi (87 ± 3% vs 79 ± 4%, p = 0.028). In multivariate analysis, the use of RASb was associated with improved survival (hazard ratio = 0.31, 95% confidence interval 0.20 to 0.47, p < 0.0001), with lower mortality under ARB than under ACEi (hazard ratio = 0.39, 95% confidence interval 0.18 to 0.85, p = 0.018). In this observational study, the use of RASb was associated with improved long-term outcome after isolated SAVR for severe AS. A randomized clinical trial is mandatory.

• Publisher: Elsevier Inc,Elsevier Limited,Elsevier
• Subject: Aged / Angiotensin / Angiotensin Receptor Antagonists - therapeutic use / Angiotensin-converting enzyme inhibitors / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Aortic stenosis / Aortic valve / Aortic Valve - surgery / Aortic Valve Stenosis - drug therapy / Aortic Valve Stenosis - mortality / Aortic Valve Stenosis - surgery / Body mass index / Body size / Cardiomyopathy / Comorbidity / Confidence intervals / Coronary vessels / Diabetes mellitus / Electrocardiography / Enzymes / Female / Heart diseases / Heart rate / Heart Valve Prosthesis / Heart Valve Prosthesis Implantation / Hospitals / Humans / Hypertension / Life Sciences / Male / Medical prognosis / Middle Aged / Mortality / Multivariate analysis / Patients / Peptidyl-dipeptidase A / Renin / Retrospective Studies / Risk Factors / Santé publique et épidémiologie / Stenosis / Surgery / Survival / Survival Rate / Treatment Outcome