Wang Shuai, Lin Xiaoxiao, Guan Yihong, Huang Jinyu
Department of Translation Medicine Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Cardiovasc Med. 2022 Aug 11;9:963731. doi: 10.3389/fcvm.2022.963731. eCollection 2022.
The objective of our systematic reviews and meta-analysis is to evaluate the clinical outcomes of RAS inhibitors for patients after TAVR.
We performed a comprehensive search for Embase, Pubmed, and Cochrane databases from inception to May 1, 2022. The analysis of all outcomes was performed using the random-effects model. In total, 7 articles with a total of 32,585 patients (RAS inhibitor, = 14,871; Controls, = 17,714) were included in our study. There was a significantly lower rates of all-cause mortality (RR = 0.76, 95%Cl = 0.68 to 0.86, < 0.01), cardiovascular death (RR = 0.66, 95%Cl = 0.59-0.74, < 0.01) and HF readmission (RR = 0.87, 95%Cl = 0.80-0.94, < 0.01) in patients with RAS inhibitors compared with controls. Patients with RAS inhibitors also had lower rates of all-cause mortality (RR = 0.82, 95%Cl = 0.76-0.89, < 0.01) and cardiovascular death (RR = 0.73, 95%Cl, 0.62-0.85, < 0.01) after propensity matching.
In conclusion, our systematic reviews and meta-analysis demonstrated that RAS inhibitors could improve the clinical outcomes for patients after TAVR. Further large and high-quality trials should be conducted to support the use of RAS inhibitors for patients after TAVR.
我们的系统评价和荟萃分析旨在评估经导管主动脉瓣置换术（TAVR）后患者使用肾素-血管紧张素系统（RAS）抑制剂的临床结局。
我们对Embase、Pubmed和Cochrane数据库进行了全面检索，检索时间从数据库建立至2022年5月1日。所有结局分析均采用随机效应模型。我们的研究共纳入7篇文章，总计32585例患者（RAS抑制剂组 = 14871例；对照组 = 17714例）。与对照组相比，RAS抑制剂组患者的全因死亡率（RR = 0.76，95%CI = 0.68至0.86，P < 0.01）、心血管死亡（RR = 0.66，95%CI = 0.59 - 0.74，P < 0.01）和心力衰竭再入院率（RR = 0.87，95%CI = 0.80 - 0.94，P < 0.01）显著更低。倾向评分匹配后，RAS抑制剂组患者的全因死亡率（RR = 0.82，95%CI = 0.76 - 0.89，P < 0.01）和心血管死亡（RR = 0.73，95%CI，0.62 - 0.85，P < 0.01）也更低。
总之，我们的系统评价和荟萃分析表明，RAS抑制剂可改善TAVR术后患者的临床结局。应开展进一步的大型高质量试验，以支持TAVR术后患者使用RAS抑制剂。
