Amat-Santos Ignacio J, Santos-Martínez Sandra, Julca Fabián, Catalá Pablo, Rodríguez-Gabella Tania, Redondo-Diéguez Alfredo, Hinojosa Williams, Veras Carlos, Campo Alberto, Serrador Frutos Ana, Carrasco-Moraleja Manuel, San Román José A
Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain.
Rev Esp Cardiol (Engl Ed). 2021 May;74(5):421-426. doi: 10.1016/j.rec.2020.03.004. Epub 2020 May 10.
To determine whether renin-angiotensin system inhibitor (RASi) prescription is associated with better outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR).
All comparative studies of RASi vs no RASi prescription in patients undergoing TAVI/SAVR were gathered from PubMed, Web of Science, and Google Scholar through August, 2019. We extracted hazard ratios (HRs) with their confidence intervals (CIs) for mortality from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random effects model.
We identified 6 eligible studies with a total of 21 390 patients (TAVI: 17 846; SAVR: 3544) and included them in the present meta-analysis. The 6 studies were observational comparative studies (including 3 propensity score matched and 3 cohort studies) of RASi vs no RASi prescription. The analysis demonstrated that RASi prescription was associated with significantly lower mortality in the whole group of patients undergoing aortic valve intervention (HR, 0.64; 95%CI, 0.47-0.88; P <.001). However, subgroup analysis suggested differences according to the selected therapy, with TAVI showing better mortality rates in the RASi group (HR, 0.67; 95%CI, 0.49-0.93) but not in the SAVR group (HR, 0.61; 95%CI, 0.29-1.30). No funnel plot asymmetry was identified, suggesting minimum publication bias. Sensitivity analyses sequentially eliminating dissimilar studies did not substantially alter the primary result favoring RASI prescription.
These findings suggest a mortality benefit of RASi in patients with AS treated with aortic valve replacement that might be particularly relevant following TAVI. Future randomized studies are warranted to confirm this relevant finding.
确定肾素-血管紧张素系统抑制剂（RASi）处方与经导管主动脉瓣植入术（TAVI）及外科主动脉瓣置换术（SAVR）后更好的预后是否相关。
通过检索PubMed、Web of Science和谷歌学术，收集截至2019年8月所有关于接受TAVI/SAVR患者使用RASi与未使用RASi处方的比较研究。我们从每项研究中提取死亡率的风险比（HRs）及其置信区间（CIs），并在随机效应模型中使用对数HRs的逆方差加权平均值合并各研究的特定估计值。
我们确定了6项符合条件的研究，共纳入21390例患者（TAVI：17846例；SAVR：3544例），并将其纳入本荟萃分析。这6项研究均为RASi与未使用RASi处方的观察性比较研究（包括3项倾向评分匹配研究和3项队列研究）。分析表明，在接受主动脉瓣干预的患者总体中，RASi处方与显著降低的死亡率相关（HR，0.64；95%CI，0.47 - 0.88；P <.001）。然而，亚组分析显示根据所选治疗方法存在差异，TAVI组中RASi组的死亡率更低（HR，0.67；95%CI，0.49 - 0.93），但SAVR组并非如此（HR，0.61；95%CI，0.29 - 1.30）。未发现漏斗图不对称，提示最小发表偏倚。依次排除不同研究的敏感性分析并未实质性改变支持RASI处方的主要结果。
这些发现表明，RASi对接受主动脉瓣置换术治疗的主动脉瓣狭窄患者有降低死亡率的益处，这在TAVI后可能尤为相关。未来有必要进行随机研究以证实这一相关发现。
