TY - JOUR
T1 - Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation
T2 - A report from a Japanese multicentre registry
AU - Yashima, Fumiaki
AU - Hara, Masahiko
AU - Inohara, Taku
AU - Jinzaki, Masahiro
AU - Shimizu, Hideyuki
AU - Fukuda, Keiichi
AU - Tanaka, Makoto
AU - Yamamoto, Masanori
AU - Watanabe, Yusuke
AU - Naganuma, Toru
AU - Shirai, Shinichi
AU - Yamawaki, Masahiro
AU - Tada, Norio
AU - Yamanaka, Futoshi
AU - Mizutani, Kazuki
AU - Ueno, Hiroshi
AU - Tabata, Minoru
AU - Takagi, Kensuke
AU - Hayashida, Kentaro
N1 - Funding Information:
Competing interests MYamam, NT, TN, SS, KM, MTab, HU and YW are clinical proctors for Edwards Lifesciences and Medtronic. HS, KT and KH are clinical proctors for Edwards Lifesciences. TI received a research grant from Boston Scientific.
Funding Information:
Funding The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical and Daiichi Sankyo Company. There are no award/grant numbers for the funders.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/6/11
Y1 - 2021/6/11
N2 - Objective Data on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients. Design Observational study. Setting This study included patients with AS from a Japanese multicentre registry who underwent TAVI. Participants The overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%-9.50%), the Euro II score was 3.74% (IQR 2.34%-6.02%) and the Clinical Frailty Scale score was 3.9±1.2. Interventions We classified patients based on statin at admission and identified 936 matched pairs after propensity score matching. Primary and secondary outcome measures The outcomes were all-cause and cardiovascular mortality. Results The median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01). Conclusions Statin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.
AB - Objective Data on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients. Design Observational study. Setting This study included patients with AS from a Japanese multicentre registry who underwent TAVI. Participants The overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%-9.50%), the Euro II score was 3.74% (IQR 2.34%-6.02%) and the Clinical Frailty Scale score was 3.9±1.2. Interventions We classified patients based on statin at admission and identified 936 matched pairs after propensity score matching. Primary and secondary outcome measures The outcomes were all-cause and cardiovascular mortality. Results The median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01). Conclusions Statin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.
KW - adult cardiology
KW - cardiology
KW - coronary heart disease
KW - valvular heart disease
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U2 - 10.1136/bmjopen-2020-044319
DO - 10.1136/bmjopen-2020-044319
M3 - Article
C2 - 34117043
AN - SCOPUS:85107921894
SN - 2044-6055
VL - 11
JO - BMJ open
JF - BMJ open
IS - 6
M1 - e044319
ER -