The clinical outcomes of reni-angiotensin system inhibitors for patients after transcatheter aortic valve replacement: A systematic review and meta-analysis

Abstract

AimsThe objective of our systematic reviews and meta-analysis is to evaluate the clinical outcomes of RAS inhibitors for patients after TAVR.Methods and resultsWe performed a comprehensive search for Embase, Pubmed, and Cochrane databases from inception to May 1, 2022. The analysis of all outcomes was performed using the random-effects model. In total, 7 articles with a total of 32,585 patients (RAS inhibitor, N = 14,871; Controls, N = 17,714) were included in our study. There was a significantly lower rates of all-cause mortality (RR = 0.76, 95%Cl = 0.68 to 0.86, P < 0.01), cardiovascular death (RR = 0.66, 95%Cl = 0.59–0.74, P < 0.01) and HF readmission (RR = 0.87, 95%Cl = 0.80–0.94, P < 0.01) in patients with RAS inhibitors compared with controls. Patients with RAS inhibitors also had lower rates of all-cause mortality (RR = 0.82, 95%Cl = 0.76–0.89, P < 0.01) and cardiovascular death (RR = 0.73, 95%Cl, 0.62–0.85, P < 0.01) after propensity matching.ConclusionsIn conclusion, our systematic reviews and meta-analysis demonstrated that RAS inhibitors could improve the clinical outcomes for patients after TAVR. Further large and high-quality trials should be conducted to support the use of RAS inhibitors for patients after TAVR.

Cardiac decompensation of patients before transcatheter aortic valve implantation—clinical presentation, responsiveness to associated medication, and prognosis

“…The beneficial effect of targeted medication at hospital discharge has already been demonstrated for ACEI/ARB ( 8 , 16 ) and statins ( 17 ) and demonstrates parallels to the effect in patients with HF. It is interesting to note that the ACEI/ARB regimen might be effective not only in stable patients without any prior CD but also in those with prior CD and even in those hospitalized for acute CD.…”

Renin–angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry

“…Until a few years ago, ACEIs/ARBs were considered potentially harmful and even contraindicated in severe AS because they could potentially cause a rapid and harmful decrease in BP levels (6). However, a recent metaanalysis that included observational and randomized evidence indicated that ACEIs/ARBs could be harmless and could even be helpful for treating AS (4,7,8).…”

Outcomes of renin‐angiotensin inhibitors following transcatheter aortic valve implantation

“…In a recent meta‐analysis of seven studies on outcomes of RAS inhibitors following TAVI, the authors showed that prescription of RAS inhibitors after TAVI resulted in lower all‐cause and cardiovascular mortality and rehospitalization for heart failure. 11 In our study, which is the most updated meta‐analysis by adding two recent studies, 5 , 9 we compared additional outcomes including stroke and myocardial infarction rate, and also two postprocedural parameters (AKI and new pacemaker implantation). In our analysis, we also combined all the reported HRs and calculated an overall hazard for all‐cause mortality.…”