Preoperative ACEi/ARB use in patients undergoing aortic valve replacement was not significantly associated with lower one-year mortality after adjustment (adjusted OR 0.33; 95% CI 0.10-1.12; p=0.075).
Cohort (n=198)
No
Does preoperative ACEi/ARB use reduce one-year all-cause mortality in patients undergoing aortic valve replacement for severe aortic stenosis?
Preoperative ACEi/ARB use in patients undergoing aortic valve replacement appears safe and is associated with numerically lower unadjusted mortality, though this finding was not statistically significant after multivariable adjustment.
Effect estimate: adjusted OR 0.33 (95% CI 0.10-1.12)
Absolute Event Rate: 7% vs 19%
p-value: p=0.075
Background: Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) were historically considered contraindicated in severe aortic stenosis (AS) due to theoretical haemodynamic risks. Contemporary evidence increasingly challenges this paradigm, yet data on preoperative use and postoperative outcomes remain limited. We examined the association between preoperative ACEi/ARB use and mortality following aortic valve replacement. Methods: We conducted a retrospective cohort study of 198 consecutive patients undergoing transcatheter (TAVI) or surgical aortic valve replacement (SAVR) at a single tertiary centre between May 2020 and March 2025. Complete one-year follow up was available for 185 patients (93%). The primary outcome was one-year all-cause mortality. Multivariable logistic regression adjusted for age, sex, hypertension, diabetes, LVEF, and procedure type. Results: Of 198 patients, 80 (40%) were receiving ACEi/ARB therapy preoperatively. ACEi/ARB users had a higher prevalence of hypertension (82% vs. 53%, p < 0.001) and diabetes (48% vs. 27%, p = 0.005) but similar age, valve area, and ejection fraction. Unadjusted one-year mortality was lower in the ACEi/ARB group (7% vs. 19%; odds ratio OR 0.33, 95% CI 0.12–0.91, p = 0.030). After multivariable adjustment for confounders including age, diabetes, and hypertension, the association did not reach statistical significance (adjusted OR 0.33, 95% CI 0.10–1.12, p = 0.075). Among diabetic patients, unadjusted one-year mortality was numerically lower in the ACEi/ARB group (12% vs. 35%, p = 0.038); however, six subgroup comparisons were performed and this result would not survive Bonferroni correction (threshold p < 0.008). This exploratory finding should be interpreted with caution given the small sample size and absence of adjustment for confounders. Conclusions: Preoperative ACEi/ARB use was associated with lower unadjusted one-year mortality, but this association did not reach statistical significance after multivariable adjustment and residual confounding cannot be excluded. ACEi/ARB use was not associated with increased mortality in this cohort. These hypothesis-generating findings from a single-centre observational study require confirmation in adequately powered prospective trials.
Abid et al. (Fri,) conducted a cohort in Severe aortic stenosis (n=198). Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) vs. No ACEi/ARB therapy was evaluated on One-year all-cause mortality (adjusted OR 0.33, 95% CI 0.10-1.12, p=0.075). Preoperative ACEi/ARB use in patients undergoing aortic valve replacement was not significantly associated with lower one-year mortality after adjustment (adjusted OR 0.33; 95% CI 0.10-1.12; p=0.075).