| 1. |
- Pan, Emily, et al.
(författare)
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Statin treatment after surgical aortic valve replacement for aortic stenosis is associated with better long-term outcome.
- 2024
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 1873-734X.
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the association between statin use after surgical aortic valve replacement for aortic stenosis and long-term risk for major adverse cardiovascular events in a large population-based, nationwide cohort.All patients that underwent isolated surgical aortic valve replacement due to aortic stenosis in Sweden 2006-2020 and survived six months after discharge were included. Individual patient data from five nationwide registries were merged. Primary outcome is major adverse cardiovascular event (defined as all-cause mortality, myocardial infarction, or stroke). Multivariable Cox regression model adjusted for age, sex, comorbidities, valve type, operation year, and secondary prevention medications is used to evaluate the association between time-updated dispense of statins and long-term outcome in the entire study population, and in subgroups based on age, sex and comorbidities.A total of 11,894 patients were included. Statins were dispensed to 49.8% (5918/11894) of patients at baseline, and 51.0% (874/1713) after ten years. At baseline, 3.6% of patients were dispensed low dose, 69.4% medium dose and 27.0% high dose statins. After adjustments, ongoing statin treatment was associated with a reduced risk for major adverse cardiovascular event [adjusted hazard ratio 0.77 (95% confidence interval 0.71-0.83). p < 0.001], mainly driven by a reduction in all-cause mortality [adjusted hazard ratio, 0.70 (0.64-0.76)], p < 0.001. The results were consistent in all subgroups.The results suggest that statin therapy might be beneficial for patients undergoing surgical aortic valve replacement for aortic stenosis. Randomized controlled trials are warranted to establish causality between statin treatment and improved outcome.
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| 2. |
- Rezk, Mary, et al.
(författare)
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Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement.
- 2023
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1873-734X. ; 63:5
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Tidskriftsartikel (refereegranskat)abstract
- Data on prognostic implications of new-onset postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) is limited. We sought to explore associations between POAF, early-initiated oral anticoagulation (OAC), and long-term outcome after SAVR and combined SAVR+CABG.This is a retrospective, population-based study including all isolated SAVR (n = 7038) and combined SAVR and CABG patients (n = 3854) without a history of preoperative atrial fibrillation in Sweden 2007-2017. Individual patient data was merged from four nationwide registries. Inverse Probability of Treatment Weighting (IPTW) adjusted Cox regression models were employed separately in SAVR and SAVR+CABG patients. Median follow-up time was 4.7 years (range 0-10 years).POAF occurred in 44.5% and 50.7% of SAVR and SAVR+CABG patients, respectively. In SAVR patients, POAF was associated with increased long-term risk of death [adjusted hazard ratio (aHR) 1.21 (95% confidence interval 1.06-1.37)], ischaemic stroke [aHR 1.32 (1.08-1.59)], any thromboembolism, heart failure hospitalization, and recurrent atrial fibrillation. In SAVR+CABG, POAF was associated with death [aHR 1.31 (1.14-1.51)], recurrent atrial fibrillation, and heart failure, but not with ischaemic stroke [aHR 1.04 (0.84-1.29)] or thromboembolism. OAC was dispensed within 30 days after discharge to 67.0% and 65.9% respectively of SAVR and SAVR+CABG patients with POAF. Early initiated OAC was not associated with reduced risk of death, ischaemic stroke or thromboembolism in any group of patients.POAF after SAVR is associated with an increased risk of long-term mortality and morbidity. Further studies are warranted to clarify the role of OAC in SAVR patients with POAF.
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| 3. |
- Törngren, Charlotta, et al.
(författare)
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Medical therapy after surgical aortic valve replacement for aortic regurgitation.
- 2023
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1873-734X. ; 63:5
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Tidskriftsartikel (refereegranskat)abstract
- Current clinical guidelines have no specific recommendations regarding medical therapy after surgical aortic valve replacement in patients with aortic regurgitation. We studied the association between medical therapy with RAS inhibitors, statins and beta-blockers, and long-term major adverse cardiovascular events.All patients undergoing valve replacement due to aortic regurgitation between 2006-2017 in Sweden and alive six months after discharge were included. Time-dependent multivariable Cox regression models adjusted for age, sex, patient characteristics, comorbidities, other medications, and year of SAVR were used. Primary outcome was a composite of all-cause mortality, myocardial infarction, and stroke. Subgroup analyses based on age, sex, heart failure, low ejection fraction, hyperlipidaemia, and hypertension were performed.A total of 2,204 patients were included (median follow-up 5.0 years (range 0.0-11.5)). At baseline, 68% of the patients were dispensed RAS inhibitors, 80% beta-blockers, and 35% statins. Dispense of RAS inhibitors and beta-blockers declined over time, especially during the first year after baseline, while dispense of statins remained stable. Treatment with RAS inhibitors or statins was associated with a reduced risk of the primary outcome (aHR 0.71, 95%CI 0.57-0.87 and aHR 0.78, 95%CI 0.62-0.99, respectively). The results were consistent in subgroups based on age, sex, and comorbidities. Beta-blocker treatment was associated with an increased risk for the primary outcome (aHR 1.35, 95%CI 1.07-1.70).The results indicate a potential beneficial association of RAS inhibitors and statins as part of a secondary preventive treatment regime after aortic valve replacement in patients with aortic regurgitation. The role of beta-blockers needs to be further investigated.
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