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Minerva Cardiology and Angiology 2021 June;69(3):299-309

DOI: 10.23736/S2724-5683.20.05289-5


lingua: Inglese

Meta-analysis of impact of renin-angiotensin system inhibitors on survival after transcatheter aortic valve implantation

Hisato TAKAGI 1, 2 , Toshiki KUNO 3, Yosuke HARI 1, 2, Kouki NAKASHIMA 1, 2, Yujiro YOKOYAMA 4, Hiroki UEYAMA 3, Tomo ANDO 5 on behalf of the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

1 Shizuoka Medical Center, Department of Cardiovascular Surgery, Shizuoka, Japan; 2 Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan; 3 Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA; 4 Department of Surgery, Easton Hospital, Easton, PA, USA; 5 Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA

INTRODUCTION: To determine whether renin-angiotensin system inhibitor (RASI) prescription is associated with better survival after transcatheter aortic valve implantation (TAVI), we performed the first meta-analysis of currently available studies.
EVIDENCE ACQUISITION: To identify all studies reporting impact of RASI prescription on survival after TAVI, we searched PubMed, Web of Science, Google Scholar, etc. through October 2019. We extracted adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence intervals (CIs) of midterm (up to ≥6-month) all-cause mortality for RASI prescription from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random-effects model.
EVIDENCE SYNTHESIS: We identified 13 eligible studies with a total of 26,132 TAVI patients and included them in the present meta-analysis. None was a randomized controlled trial, 5 were observational studies comparing patients with versus without RASI prescription (including 3 propensity score matched studies), and 8 were observational studies investigating RASI prescription as one of covariates. The primary meta-analysis of all studies demonstrated that RASI prescription was associated with significantly lower midterm mortality (HR=0.83; 95% CI: 0.76 to 0.92; P=0.0002). Although we identified significant funnel plot asymmetry (P=0.036 by the rank correlation test) suggesting publication bias, correcting for it using the trim-and-fill method did not substantially alter the result favoring RASI prescription (corrected HR=0.85; 95% CI: 0.76 to 0.95; P=0.004).
CONCLUSIONS: RASI prescription may be associated with better midterm survival after TAVI.

KEY WORDS: Meta-analysis; Survival; Renin-angiotensin system; Aortic valve

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