Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China.
Department of Cardiovascular surgery, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China.
Catheter Cardiovasc Interv. 2021 Jan 1;97(1):E88-E94. doi: 10.1002/ccd.28899. Epub 2020 Apr 20.
We aimed to evaluate the impact of renin-angiotensin system (RAS) inhibitors on outcomes after transcatheter aortic valve replacement (TAVR).
The impact of RAS inhibitors on outcomes after TAVR was unclear.
A systematic review of articles comparing outcomes of patients using and not using RAS inhibitors after TAVR was performed through PubMed, Embase, and Cochrane. Primary outcome was midterm all-cause mortality. Risk ratios (RRs) were calculated with the corresponding 95% confidence interval using random effect models.
Five studies with 23,319 patients were included. Patients treated with RAS inhibitors had lower midterm all-cause mortality after TAVR than those without RAS inhibitors in both the unmatched (13.3 vs. 17.2%, RR 0.77, p = .005) and propensity score matched cohorts (13.5 vs 16.2%, RR 0.83, p < .001). Cardiovascular mortality (10.4 vs. 15.6%, RR 0.68, p < .001), rate of heart failure readmission (12.2 vs. 14.5%, RR 0.80, p = .006), and new-onset atrial fibrillation (14.0 vs. 23.7%, RR 0.73, p = .003) were also lower with RAS inhibitors. No difference was found between two groups regarding cerebrovascular events, myocardial infarction, major bleeding, major vascular complications, acute kidney injury, permanent pacemaker implantation, and moderate/severe paravalvular aortic regurgitation.
RAS inhibitors were associated with lower midterm all-cause mortality after TAVR.
我们旨在评估肾素-血管紧张素系统（RAS）抑制剂对经导管主动脉瓣置换术（TAVR）后结局的影响。
RAS 抑制剂对 TAVR 后结局的影响尚不清楚。
通过 PubMed、Embase 和 Cochrane 系统地回顾了比较 TAVR 后使用和不使用 RAS 抑制剂的患者结局的文章。主要结局是中期全因死亡率。使用随机效应模型计算相应的 95%置信区间的风险比（RR）。
纳入了 5 项研究共 23319 例患者。在未匹配和倾向评分匹配队列中，与未使用 RAS 抑制剂的患者相比，使用 RAS 抑制剂的患者 TAVR 后中期全因死亡率更低（分别为 13.3%和 17.2%，RR 0.77，p =.005；13.5%和 16.2%，RR 0.83，p < .001）。心血管死亡率（10.4%和 15.6%，RR 0.68，p < .001）、心力衰竭再入院率（12.2%和 14.5%，RR 0.80，p =.006）和新发心房颤动（14.0%和 23.7%，RR 0.73，p =.003）也更低。两组之间在脑血管事件、心肌梗死、大出血、大血管并发症、急性肾损伤、永久性心脏起搏器植入和中度/重度瓣周主动脉反流方面无差异。
RAS 抑制剂与 TAVR 后中期全因死亡率降低相关。
