Our Experience with Transcatheter Aortic Valve Replacement Medication Outcomes from 2013 to 2016

Abstract

BackgroundAortic stenosis is classified as stenosis that can be caused by a congenital disability in infants and children but is more commonly produced by a degenerative process of calcification and scarring of the valve in the later decades of life. High systemic pressure and hemodynamic disturbances characteristic of this area of the cardiovascular system makes the aortic valve susceptible to plaque and cholesterol buildup over time, similarly to atherosclerosis, contributing to the pathology of aortic stenosis. Thus, this study aims to assess the short and long-term clinical outcomes of risk factor reduction, post transcatheter aortic valve replacement (post-TAVR), and results of tested medication outcomes.MethodsData were obtained from Charleston Area Medical Center, which is a tertiary care 800-bed community teaching facility and was examined using STATA 11.4 (StataCorp LLC, College Station, Texas, USA), a Cox proportional hazards model to test for clinical significance. This study examined the medications aspirin, clopidogrel, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Additional medications analyzed included statin, anticoagulant, aspirin with clopidogrel, and beta-blocker with ACE inhibitor and statin following the procedure of transcatheter aortic valve replacement (TAVR) and the overall risk of a hazard event of mortality.ResultsResults suggest that clopidogrel by itself had the lower rate of mortality at one year with hazards of 0.6906, a p-value of 0.221 and a 95% confidence interval of 0.3677 - 1.259; and at three years with hazards of 0.4845, a p-value of 0.027 and a 95% confidence interval of 0.2552 - 0.9201. Statins had the second-lowest rate at one year with hazards of 0.7299 and a p-value 0.215 and a 95% confidence interval of 0.4438 - 1.200; and at three years with hazard of 0.8529 and a p-value of 0.530 and a 95% confidence interval of 0.5192 - 1.401. Both of these medications had a consistent lower hazard and/or risk of death compared to other standard medication regiments. Within our center's data, clopidogrel had the best clinical outcome. ConclusionsThis study showed that therapy with aspirin and clopidogrel alone did not demonstrate a significant increase in mortality versus alternative anticoagulation therapy in patients post aortic valve replacement. Clopidogrel and statin usage post-aortic valve revascularization may have a trend towards a reduction in mortality.

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

“…The result of analysis for twelve studies 9-11,15-19,21,23,25,26 that reported HR, also favored statin therapy (HR = .78, 95% CI 0.64-.93, P = .0063; I 2 = 53.2%, Q value = 23.51, P = .0149) (Figure 4).

Figure 4.Comparison of the impact of statin vs no statin therapy on all-cause mortality in studies that reported hazard ratio.

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“…The sensitivity analysis of the 9 high-quality studies 9-11,16,17,21-23,28,29 with low risk of bias indicated a lower risk of all-cause mortality in patients who received statin therapy (HR = .75, 95% CI 0.66-.85, P < .0001; I 2 = 55.3%, Q value = 17.90, P = .0220) (Figure 3). However, the analysis for low-quality studies did not show any beneficial effect for statin therapy (HR = .92, 95% CI 0.70–1.20, P = .52; I 2 = 29.0%, Q value = 9.86, P = .1969).

Figure 3.Comparison of the impact of statin vs no statin therapy on all-cause mortality among high-quality and low-quality studies.

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“…In their study, the use of statins did decrease the incidence of stroke or TIA in the in-hospital and discharge to 30 days post-TAVI time periods. Herron et al, 11 also reported that 1- or 3-year mortality was not associated with statin therapy. The pooled HR of low-quality studies did not suggest the beneficial effect of statin in reducing overall mortality.…”

“…Full texts of 48 possible eligible articles were reviewed. Finally, after a thorough full-text review, 17 [9][10][11][15][16][17][18][19][20][21][22][23][24][25][26][27][28] articles with 21 380 patients were included in the metaanalysis. The flow chart presenting the selection of the articles is shown in (Figure 1).…”

“…9,10 However beneficial effect of statin therapy was not observed in some other studies. 11 Thus, whether statins could improve survival after TAVI remains unclear. Hence, we aimed to perform a systematic review and meta-analysis to evaluate the impact of statin after TAVI.…”