Document Detail


Renin-Angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: a cohort study.
MedLine Citation:
PMID:  25402513     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Data are lacking on the effect of renin-angiotensin system (RAS) blockade therapy with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers after surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS).
OBJECTIVE: To investigate the association between RAS blockade therapy and outcomes after SAVR for severe AS.
DESIGN: Retrospective study.
SETTING: Single tertiary referral care center.
PATIENTS: Patients who were prescribed angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers after SAVR for severe AS between 1991 and 2010 who had at least 2 refills 90 days apart and at least a 6-month follow-up constituted the RAS blockade group (n = 741). Patients who did not receive these prescriptions were in the untreated group (n = 1011). Unadjusted and propensity-matched analyses (594 matched pairs of treated and untreated patients) were performed.
MEASUREMENTS: The primary outcome was survival rates after SAVR. Secondary end points were changes in left ventricular mass index, left ventricular ejection fraction, and left atrial size.
RESULTS: Overall unadjusted estimated survival rates at 1, 5, and 10 years were significantly greater in the RAS blockade group than in the non-RAS blockade group (99%, 90%, and 60% vs. 99%, 81%, and 53%, respectively; P < 0.001). Among propensity-matched patients, estimated survival rates at 1, 5, and 10 years remained significantly greater in the RAS blockade group than in the non-RAS blockade group (99%, 90%, and 71% vs. 96%, 78%, and 49%, respectively; P < 0.001). For the matched cohorts, the groups did not significantly differ in the change in left ventricular mass index (P = 0.37), left ventricular ejection fraction (P = 0.67), or left atrial size (P = 0.43) after SAVR on echocardiographic analysis.
LIMITATION: Retrospective, single-center analysis.
CONCLUSION: Renin-angiotensin system blockade therapy is associated with increased survival rates in patients after SAVR for severe AS. A randomized trial of RAS blockade therapy after SAVR should be considered.
PRIMARY FUNDING SOURCE: None.
Authors:
Sachin S Goel; Olcay Aksoy; Supriya Gupta; Penny L Houghtaling; E Murat Tuzcu; Thomas Marwick; Tomislav Mihaljevic; Lars Svensson; Eugene H Blackstone; Brian P Griffin; William J Stewart; Benico Barzilai; Venu Menon; Samir R Kapadia
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  161     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  699-710     Citation Subset:  AIM; IM    
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