RAS inhibitor therapy after TAVR showed a 79.4% probability to reduce all-cause mortality and 99.5% for cardiovascular mortality, with moderate heart failure readmission benefit.
Does renin-angiotensin system inhibitor therapy reduce mortality and heart failure hospitalization in patients following TAVR?
RAS inhibitor therapy following TAVR is associated with a high probability of clinically relevant reductions in all-cause and cardiovascular mortality.
Absolute Event Rate: 0% vs 0%
ABSTRACT Background Aortic stenosis leads to left ventricular remodeling, hypertrophy, and fibrosis, increasing the risk of heart failure. Renin−angiotensin system (RAS) inhibitors may mitigate these adverse effects and improve clinical outcomes. Despite advancements in transcatheter aortic valve replacement (TAVR), substantial mortality, heart failure readmissions, and other complications persist. Aims This study aimed to evaluate the impact of RAS inhibitor therapy following TAVR on clinical outcomes. Methods We conducted a systematic review and Bayesian meta‐analysis following the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search of PubMed, Embase, and Cochrane was performed to identify studies comparing RAS inhibitor (RASi) use versus non‐use in patients undergoing TAVR for aortic stenosis. Odds ratios (OR) and 95% credible intervals (CrI) were estimated using a Bayesian random‐effects model. Between‐study heterogeneity was quantified using the posterior distribution of the heterogeneity parameter (τ). Posterior probabilities (PP) of treatment benefit were calculated, with clinically meaningful effects defined as P (OR < 0.8). All analyses were performed using R version 4.5.0. Results A total of 12 studies comprising 35,988 patients were included, of whom 17,026 (47.3%) received RASi therapy. The mean age ranged from 78.9 to 84.4 years. Post‐TAVR RASi use was associated with a 79.4% probability of a clinically relevant reduction in all‐cause mortality and a 99.5% probability of a clinically relevant reduction in cardiovascular mortality. There was a 54% probability of a clinically relevant reduction in heart failure hospitalization and a negligible (2.26%) probability of a reduction in the odds of myocardial infarction in the RASi group. Conclusions RASi therapy following TAVR is associated with reduced odds of mortality and heart failure readmission.
Oliveira et al. (Sun,) reported a other. RAS inhibitor therapy after TAVR showed a 79.4% probability to reduce all-cause mortality and 99.5% for cardiovascular mortality, with moderate heart failure readmission benefit.
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