Abstract 13431: Impact of Renin-Angiotensin System Blockade Therapy Post Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis
Background: Renin angiotensin system (RAS) blockade with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) have clinical and survival benefit in patients with heart failure. Persistent heart failure after surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) is associated with poor outcome. Data is lacking on the role of ACEI/ARB therapy on outcomes of patients with severe AS post SAVR. Aims: To investigate the impact of RAS blockade therapy on outcomes in patients with severe AS after SAVR.
Methods: From 1991 to 2010, 4370 patients underwent SAVR for severe AS. Patients discharged on ACEI/ARB after SAVR with at least 2 refills 90 days apart constituted the ACE/ARB (RAS) group (n=754) and those not prescribed ACEI/ARB were the control group (n=3616). Unadjusted and propensity matched (case:control ratio of 1:1 yielding 754 matched pairs) analyses were performed. Endpoints include short and long term survival.
Results: Patients with hypertension, older age and greater left ventricular dysfunction were more likely to be on ACE/ARB post SAVR. There were a total of 1567 deaths over a median follow up of 12 ± 5.1 years. Overall unadjusted estimated survival at 1, 5 and 10 years was 99%, 89% and 69% in the RAS group compared to 96%, 77% and 49% respectively in the non-RAS group (p<0.0001). Among propensity matched patients, estimated survival at 1, 5 and 10 years remained significantly higher in the RAS group compared to non-RAS group (99%, 89% and 69% vs 96%, 79% and 48%, respectively p<0.001). When stratified by SAVR alone (RAS n=357, non-RAS n=1872) and SAVR with concomitant CABG (RAS n=397, non RAS n=1744), survival remained significantly higher in the RAS group (unadjusted as well as propensity matched, p<0.0001).
Conclusion: RAS blockade with ACEI/ARB post SAVR is associated with an improved survival in patients with severe AS. .
- © 2012 by American Heart Association, Inc.