Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands
Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands.
Open Heart. 2023 Oct;10(2). doi: 10.1136/openhrt-2023-002348.
Studies have found statin treatment to be associated with improved 1-year survival after transcatheter aortic valve implantation (TAVI), suggesting pleiotropic effects of statins on preventing perioperative complications. Statin treatment is not associated with postoperative cardiovascular complications or mortality; however, other postoperative complications have not been investigated.
To explore whether preoperative statin treatment is associated with a lower short-term risk of mortality, readmission and major postoperative complications in older patients undergoing TAVI.
A retrospective cohort study including patients aged 65 years and older who had undergone a comprehensive geriatric assessment prior to TAVI between January 2014 and January 2021. The primary outcomes were 90-day mortality, 90-day readmissions and major postoperative complications according to the Clavien-Dindo classification. Multivariable logistic regression was performed with adjustment for potential confounders, namely age, gender, comorbidity, body mass index, smoking, diminished renal function, alcohol use and falls .
This study included 584 patients, of whom 324 (55.5%) were treated with a statin. In the statin treated group, 15 (4.6%) patients died within 90 days of TAVI compared with 10 (3.8%) patients in the non statin group (adjusted OR 1.17; 95% CI 0.51 to 2.70). The number of 90-day readmissions was 39 (12.0%) and 34 (13.1%) (adjusted OR 0.91; 95% CI 0.54 to 1.52), respectively. In the statin treated group, 115 (35.5%) patients experienced a major complication compared with 98 (37.7%) in the non-statin group (adjusted OR 0.95; 95% CI 0.67 to 1.37).
Preoperative statin treatment is not associated with improved short-term outcomes after TAVI. A randomised controlled trial with different statin doses may be warranted to investigate whether initiating statin treatment before TAVI improves both postoperative outcomes and long-term survival.
研究发现他汀类药物治疗与经导管主动脉瓣植入术（TAVI）后 1 年生存率的提高有关，这表明他汀类药物在预防围手术期并发症方面具有多效性。他汀类药物治疗与术后心血管并发症或死亡率无关；然而，其他术后并发症尚未得到研究。
探讨他汀类药物治疗是否与 TAVI 老年患者的短期死亡率、再入院率和主要术后并发症降低相关。
本研究回顾性纳入了 2014 年 1 月至 2021 年 1 月期间在 TAVI 术前接受全面老年评估的年龄≥ 65 岁患者。主要结局为 90 天死亡率、90 天再入院率和根据 Clavien-Dindo 分类的主要术后并发症。多变量逻辑回归用于调整潜在混杂因素，包括年龄、性别、合并症、体重指数、吸烟、肾功能减退、饮酒和跌倒。
本研究纳入了 584 名患者，其中 324 名（55.5%）接受了他汀类药物治疗。在他汀类药物治疗组中，15 名（4.6%）患者在 TAVI 后 90 天内死亡，而非他汀类药物治疗组中为 10 名（3.8%）（调整后的 OR 1.17；95%CI 0.51 至 2.70）。90 天再入院人数分别为 39 例（12.0%）和 34 例（13.1%）（调整后的 OR 0.91；95%CI 0.54 至 1.52）。在他汀类药物治疗组中，115 名（35.5%）患者发生主要并发症，而非他汀类药物治疗组为 98 名（37.7%）（调整后的 OR 0.95；95%CI 0.67 至 1.37）。
TAVI 术后，术前他汀类药物治疗与短期结局改善无关。可能需要进行随机对照试验，以不同剂量的他汀类药物治疗，来研究 TAVI 前开始他汀类药物治疗是否能改善术后结局和长期生存率。
