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Comparison of long-term mortality in patients who underwent transcatheter aortic valve replacement with or without anti-atherosclerotic therapy

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Abstract

Atherosclerosis is a risk factor for both aortic stenosis (AS) and coronary artery disease. This study aimed to investigate whether anti-atherosclerotic therapy (AT), defined as the simultaneous use of antiplatelet agents, statins, and renin aldosterone system inhibitors, had long-term clinical benefits for patients who underwent transcatheter aortic valve replacement (TAVR). Between October 2013 and May 2017, 2518 patients (31% men; median age, 85 years) who underwent TAVR in 14 Japanese centers were divided into two groups: patients who were prescribed anti-atherosclerotic therapy (AT, n = 567) and patients who were not (no AT, n = 1951). The median follow-up period for this cohort was 693 days (interquartile range, 389–870 days). Compared to no AT group, AT group was associated with significantly lower 2-year all-cause mortality (11.7% vs. 16.5%; log-rank p = 0.002) and 2-year cardiovascular mortality rates (3.5% vs. 6.0%; log-rank p = 0.017). In a propensity-matched cohort (n = 495 each; median follow-up, 710 days [IQR, 394 − 896 days]), patients in AT group had a lower prevalence of 2-year cardiovascular mortality (3.8% vs. 6.2%, log-rank p = 0.024) than that in the no AT group. In the multivariate stepwise regression analysis, AT was a significant predictor of cardiovascular mortality (hazard ratio 0.45; 95% confidence interval 0.25–0.80; p = 0.007). AT may improve survival in post-TAVR patients. Future studies are necessary to identify an optimal treatment regimen to improve long-term outcomes after TAVR.

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Funding

The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, Boston Scientific, and Daiichi-Sankyo Company.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Tokyo, 173-8606, Japan

    Kazuya Sasaki, Yusuke Watanabe, Ken Kozuma, Akihisa Kataoka, Hirofumi Hioki & Fukuko Nagura

  2. Department of Cardiology, Utsunomiya Saiseikai Hospital, Tochigi, Japan

    Yashima Fumiaki

  3. Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan

    Shinichi Shirai

  4. Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan

    Norio Tada

  5. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan

    Masahiro Yamawaki

  6. Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan

    Toru Naganuma

  7. Department of Cardiovascular Medicine and Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Toru Naganuma

  8. Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan

    Futoshi Yamanaka

  9. The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan

    Hiroshi Ueno

  10. Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan

    Minoru Tabata

  11. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

    Kazuki Mizutani

  12. Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan

    Kensuke Takagi

  13. Division of Cardiovascular Medicine, Toyohashi Heart Center and Nagoya Heart Center, Aichi, Japan

    Masanori Yamamoto

  14. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

    Kentaro Hayashida

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  1. Kazuya Sasaki
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  2. Yusuke Watanabe
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  3. Ken Kozuma
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  4. Akihisa Kataoka
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  5. Hirofumi Hioki
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  6. Fukuko Nagura
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  7. Yashima Fumiaki
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  8. Shinichi Shirai
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  9. Norio Tada
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  10. Masahiro Yamawaki
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  11. Toru Naganuma
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  12. Futoshi Yamanaka
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  13. Hiroshi Ueno
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  14. Minoru Tabata
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  15. Kazuki Mizutani
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  16. Kensuke Takagi
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  17. Masanori Yamamoto
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  18. Kentaro Hayashida
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Correspondence to Yusuke Watanabe.

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Sasaki, K., Watanabe, Y., Kozuma, K. et al. Comparison of long-term mortality in patients who underwent transcatheter aortic valve replacement with or without anti-atherosclerotic therapy. Heart Vessels 36, 1892–1902 (2021). https://doi.org/10.1007/s00380-021-01873-4

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  • DOI: https://doi.org/10.1007/s00380-021-01873-4

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