Renin-angiotensin system blockade therapy after surgical aortic valve replacement for severe aortic stenosis: a cohort study.
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.


METHODS
Retrospective study.


METHODS
Single tertiary referral care center.


METHODS
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.


METHODS
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.


CONCLUSIONS
Retrospective, single-center analysis.


CONCLUSIONS
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.


BACKGROUND
None.
Sachin S
SS
Goel
Olcay
O
Aksoy
Supriya
S
Gupta
Penny L
PL
Houghtaling
E Murat
EM
Tuzcu
Thomas
T
Marwick
Tomislav
T
Mihaljevic
Lars
L
Svensson
Eugene H
EH
Blackstone
Brian P
BP
Griffin
William J
WJ
Stewart
Benico
B
Barzilai
Venu
V
Menon
Samir R
SR
Kapadia
D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D015996:Survival Rate; D014463:Ultrasonography
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors