Shizuoka Medical Center, Department of Cardiovascular Surgery, Shizuoka, Japan -
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan -
Minerva Cardiol Angiol. 2021 Jun;69(3):299-309. doi: 10.23736/S2724-5683.20.05289-5. Epub 2021 Mar 11.
To determine whether renin-angiotensin system inhibitor (RASI) prescription is associated with better survival after transcatheter aortic valve implantation (TAVI), we performed the first meta-analysis of currently available studies.
To identify all studies reporting impact of RASI prescription on survival after TAVI, we searched PubMed, Web of Science, Google Scholar, etc. through October 2019. We extracted adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence intervals (CIs) of midterm (up to ≥6-month) all-cause mortality for RASI prescription from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random-effects model.
We identified 13 eligible studies with a total of 26,132 TAVI patients and included them in the present meta-analysis. None was a randomized controlled trial, 5 were observational studies comparing patients with versus without RASI prescription (including 3 propensity score matched studies), and 8 were observational studies investigating RASI prescription as one of covariates. The primary meta-analysis of all studies demonstrated that RASI prescription was associated with significantly lower midterm mortality (HR=0.83; 95% CI: 0.76 to 0.92; P=0.0002). Although we identified significant funnel plot asymmetry (P=0.036 by the rank correlation test) suggesting publication bias, correcting for it using the trim-and-fill method did not substantially alter the result favoring RASI prescription (corrected HR=0.85; 95% CI: 0.76 to 0.95; P=0.004).
RASI prescription may be associated with better midterm survival after TAVI.
为了确定肾素-血管紧张素系统抑制剂（RASI）的处方是否与经导管主动脉瓣植入术（TAVI）后的生存改善相关，我们对目前可用的研究进行了首次荟萃分析。
为了确定所有报告 RASI 处方对 TAVI 后生存影响的研究，我们通过 2019 年 10 月在 PubMed、Web of Science、Google Scholar 等进行了搜索。我们从每项研究中提取了调整后的（如果不可用，则提取未调整的）中期（最长至≥6 个月）全因死亡率的风险比（HR）及其置信区间（CI），并使用随机效应模型中对数 HR 的倒数方差加权平均值对研究特异性估计值进行合并。
我们确定了 13 项符合条件的研究，共纳入 26132 例 TAVI 患者，并将其纳入本荟萃分析。没有随机对照试验，其中 5 项为比较 RASI 处方与无 RASI 处方患者的观察性研究（包括 3 项倾向评分匹配研究），8 项为将 RASI 处方作为协变量之一进行研究的观察性研究。所有研究的主要荟萃分析表明，RASI 处方与中期死亡率显著降低相关（HR=0.83；95%CI：0.76 至 0.92；P=0.0002）。尽管我们发现漏斗图存在显著的不对称性（秩相关检验 P=0.036），提示存在发表偏倚，但使用填充法进行校正并未显著改变支持 RASI 处方的结果（校正后的 HR=0.85；95%CI：0.76 至 0.95；P=0.004）。
RASI 处方可能与 TAVI 后中期生存改善相关。
