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Shah T, Maarek R, See C, Huang H, Wang Y, Parise H, Forrest JK, Lansky AJ. Effect of antecedent statin usage on conduction disturbances and arrhythmias after transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:3-8. [PMID: 37573173 DOI: 10.1016/j.carrev.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Post-transcatheter aortic valve replacement (TAVR) conduction disturbances and atrial fibrillation (AF) are associated with markedly worse short- and long-term prognosis. Statins have multiple pleotropic effects that may be beneficial in mitigating the risk of these procedural complications as has been found for various other cardiac procedures and surgeries. METHODS Data were retrospectively collected on consecutive patients in the Yale New Haven Health TAVR Registry who did not have a prior pacemaker, had at least 1 pre- and post-TAVR electrocardiogram, and did not have a change to their statin regimen during the index hospitalization. The primary endpoint was the composite of new pacemaker placement, new AF, and other new conduction disturbances evaluated at 7 days post-TAVR. RESULTS Between, July 2012 and August 2019, 612 patients met inclusion criteria. Of these, 162 patients were not on antecedent statins, and 450 were (28 low-intensity, 225 moderate-intensity, and 197 high-intensity). After 1:1 propensity matching, 99 patients on moderate-/high-intensity statins were matched to 99 patients not on antecedent statins. At 7 days, there was no significant difference in the occurrence of the primary endpoint (57 % statin users vs 46 % non-statin users; p = 0.16). There was a trend toward increased conduction disturbances 7 days after TAVR in statin users (56 % vs 42 %; p = 0.07), but rates of AF (5 % vs 8 %; p = 0.39) and pacemaker placement (9 % vs 15 %; p = 0.20) were numerically lower in statin users. There was no significant difference in persistent conduction disturbances (21 % vs 18 %; p = 0.59). CONCLUSIONS Statins do not appear to reduce the risk of post-TAVR AF or conduction abnormalities in this small retrospective study.
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Affiliation(s)
- Tayyab Shah
- Yale School of Medicine, New Haven, CT, United States of America
| | - Rafael Maarek
- Yale School of Medicine, New Haven, CT, United States of America
| | - Claudia See
- Yale School of Medicine, New Haven, CT, United States of America
| | - Haocheng Huang
- Yale School of Medicine, New Haven, CT, United States of America
| | - Yanting Wang
- Yale School of Medicine, New Haven, CT, United States of America
| | - Helen Parise
- Yale School of Medicine, New Haven, CT, United States of America
| | - John K Forrest
- Yale School of Medicine, New Haven, CT, United States of America
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Lefeber G, Dautzenberg L, Knol W, Huijbers C, Voskuil M, Kraaijeveld AO, Bouvy M, de Boer A, Emmelot-Vonk M, Koek HL. Association between perioperative statin treatment and short-term clinical outcomes following transcatheter aortic valve implantation: a retrospective cohort study. Open Heart 2023; 10:e002348. [PMID: 37890893 PMCID: PMC10619010 DOI: 10.1136/openhrt-2023-002348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/01/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Studies have found statin treatment to be associated with improved 1-year survival after transcatheter aortic valve implantation (TAVI), suggesting pleiotropic effects of statins on preventing perioperative complications. Statin treatment is not associated with postoperative cardiovascular complications or mortality; however, other postoperative complications have not been investigated. AIM To explore whether preoperative statin treatment is associated with a lower short-term risk of mortality, readmission and major postoperative complications in older patients undergoing TAVI. METHODS A retrospective cohort study including patients aged 65 years and older who had undergone a comprehensive geriatric assessment prior to TAVI between January 2014 and January 2021. The primary outcomes were 90-day mortality, 90-day readmissions and major postoperative complications according to the Clavien-Dindo classification. Multivariable logistic regression was performed with adjustment for potential confounders, namely age, gender, comorbidity, body mass index, smoking, diminished renal function, alcohol use and falls . RESULTS This study included 584 patients, of whom 324 (55.5%) were treated with a statin. In the statin treated group, 15 (4.6%) patients died within 90 days of TAVI compared with 10 (3.8%) patients in the non statin group (adjusted OR 1.17; 95% CI 0.51 to 2.70). The number of 90-day readmissions was 39 (12.0%) and 34 (13.1%) (adjusted OR 0.91; 95% CI 0.54 to 1.52), respectively. In the statin treated group, 115 (35.5%) patients experienced a major complication compared with 98 (37.7%) in the non-statin group (adjusted OR 0.95; 95% CI 0.67 to 1.37). CONCLUSION Preoperative statin treatment is not associated with improved short-term outcomes after TAVI. A randomised controlled trial with different statin doses may be warranted to investigate whether initiating statin treatment before TAVI improves both postoperative outcomes and long-term survival.
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Affiliation(s)
- Geert Lefeber
- Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands
| | - Lauren Dautzenberg
- Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands
| | - Carla Huijbers
- Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | | | | | - Marcel Bouvy
- Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Anthonius de Boer
- Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | | | - Huiberdina L Koek
- Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands
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Nowak MM, Niemczyk M, Florczyk M, Kurzyna M, Pączek L. Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies. J Clin Med 2022; 11:jcm11195643. [PMID: 36233511 PMCID: PMC9572734 DOI: 10.3390/jcm11195643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Statins are lipid-lowering medications used for the prevention of cardiovascular disease (CVD), but the pleiotropic effects of statins might be beneficial in other chronic diseases. This meta-analysis investigated the association between statin use and mortality in different chronic conditions. Eligible studies were real-world studies that compared all-cause mortality over at least 12 months between propensity score-matched statin users and non-users. Overall, 54 studies were included: 21 in CVD, 6 in chronic kidney disease, 6 in chronic inflammatory diseases, 3 in cancer, and 18 in other diseases. The risk of all-cause mortality was significantly reduced in statin users (hazard ratio: 0.72, 95% confidence interval: 0.66−0.76). The reduction in mortality risk was similar in CVD studies (0.73, 0.66−0.76) and non-CVD studies (0.70, 0.67−0.79). There were no significant differences in the risk reduction between cohorts with different diseases (p = 0.179). The greatest mortality reduction was seen in studies from Asia (0.61, 0.61−0.73) and the lowest in studies from North America (0.78, 0.73−0.83) and Australia (0.78, 0.62−0.97). There was a significant heterogeneity (I2 = 95%, tau2 = 0.029, p < 0.01). In conclusion, statin use was associated with a significantly reduced risk of all-cause mortality in real-world cohorts with CVD and non-CVD.
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Affiliation(s)
- Marcin M. Nowak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
- Correspondence:
| | - Mariusz Niemczyk
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
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Yarahmadi P, Kabiri A, Forouzannia SM, Yousefifard M. Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis. Angiology 2022:33197221124778. [PMID: 36067358 DOI: 10.1177/00033197221124778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While TAVI is widely used, optimal medical therapy to reduce the mortality rate after transcatheter aortic valve implantation (TAVI) is still unclear. We performed a systematic review and meta-analysis to evaluate the impact of statins on mortality following TAVI. Present systematic review of the literature was performed using Medline, Embase, Scopus, and Web of Science; all studies reported all-cause mortality in patients who underwent TAVI and received or did not receive statin therapy. Data were analyzed using random-effects models. Seventeen articles (21 380 patients) were included in the meta-analysis. Statin therapy was associated with a reduction of all-cause mortality (Hazard ratio [HR] = .78, 95% Confidence interval [CI] .68-.89, P < .001). Moderate between-study heterogeneity was observed (I2 = 45.2). High-intensity statin therapy was more effective than low or moderate intensity statin therapy in reduction of all-cause mortality (Risk ratio [RR] = .62, 95% CI 0.45-.85, P = .003, I2 = .0). Statin therapy could reduce the mid-term all-cause mortality rate following TAVI. However, all included studies were observational and, therefore, randomized controlled trials are still needed to assess the effect of statin therapy on mortality after TAVI.
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Affiliation(s)
- Pourya Yarahmadi
- School of Medicine, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kabiri
- School of Medicine, 440827Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahmoud Yousefifard
- Physiology Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
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Baranowska J, Törngren C, Nielsen SJ, Lindgren M, Björklund E, Ravn-Fischer A, Skoglund K, Jeppsson A, Martinsson A. Associations between medical therapy after surgical aortic valve replacement for aortic stenosis and long-term mortality: a report from the SWEDEHEART registry. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:837-846. [PMID: 35583235 PMCID: PMC9716862 DOI: 10.1093/ehjcvp/pvac034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 12/29/2022]
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 < 0.001} and RAS inhibitors [aHR 0.84 (0.76-0.93); P < 0.001] but not for β-blockers [aHR 1.17 (1.05-1.30); P = 0.004]. The associations were robust in subgroups based on age, sex, and comorbidities (P for interactions >0.05). CONCLUSIONS The results of this large population-based real-world study support the use of statins and RAS inhibitors for patients who underwent SAVR due to AS.
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Affiliation(s)
- Julia Baranowska
- Department of Cardiology, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Charlotta Törngren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Medicine, South Älvsborg Hospital, Borås, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Cardiology, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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