Author + information
- Victor Aboyans,
- Julien Magne,
- Barthelemy Guinot,
- Antoine Bourgeois,
- Alessandro Piccardo,
- Alexandre Le Guyader and
- Dania Mohty
Background: Angiotensin receptors blockers (ARB) and angiotensin conversion enzyme inhibitors (ACEi) are effective for cardiac remodeling, but their clinical interest after isolated aortic valve replacement (AVR) for aortic stenosis (AS) is unclear. We studied the impact of renin-angiotensin blockers (RASb) on survival after AVR for AS.
Methods: From 01/2005 to 01/2014, 508 consecutive patients had isolated surgical AVR for severe AS. A propensity score (PS) was calculated. 96 PS-matched pairs of RASb+ and RASb- were compared.
Results: RASb+ patients (n=286) were more often women (p=0.04), hypertensive (p<0.0001) and diabetic (p=0.003), with higher body mass index (p<0.001) and Euroscore II (p=0.03), and lower mean aortic pressure gradient (p=0.01). 30-day mortality was similar in both groups (RASb+: 3.6%, RASb- 6.2%, p=0.18), but with lower rates under ARB than ACEi (0.4% vs. 3.2%, p=0.046). After a mean follow-up of 4.8±2.7 years, RASb+ patients had a better outcome than RASb- patients (Fig), confirmed in the PS-matched pairs analysis. Those with ARB had lower mortality vs. those with ACEi (p=0.028). In multivariate analysis, RASb were associated with improved survival (HR=0.33, 95%CI:0.21-0.52, p<0.001), with lower mortality under ARB vs. ACEi (HR=0.44, 95%CI: 0.21-0.90, p=0.03). Similar results were obtained with drugs at discharge.
Conclusions: Use of RASb, and especially ARB, was associated with better long-term survival after AVR for AS. A randomized trial is necessary for confirmation.
Room 204 A
Sunday, March 19, 2017, 8:12 a.m.-8:22 a.m.
Session Title: Highlighted Original Research: Valvular Heart Disease and the Year in Review
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 912-04
- 2017 American College of Cardiology Foundation