Medical therapy after surgical aortic valve replacement for aortic regurgitation.

• 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Aortic regurgitation

Medical therapy

Renin–angiotensin system inhibitors

Statins

surgical aortic valve replacement

β-Blockers

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)