MedicalResearch.com Interview with:
Taku Inohara MD, PhD
Duke Clinical Research Institute,
Duke University Medical Center,
Durham, North Carolina
Department of Cardiology
Keio University School of Medicine, Tokyo, Japan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Transcatheter aortic valve replacement (TAVR) has been increasingly used for treating patients with severe aortic stenosis.
Owing to the advancement of TAVR technology, the mortality and heart failure (HF) readmission after TAVR is decreasing over time, but 4.3% experienced readmission due to HF and 23.7% died within 1 year after TAVR. Inhibition of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin-receptor blockers (ARBs) is known to improve clinical outcomes in patients with heart failure, but there remains unknown whether a RAS inhibitor is associated with a reduction in mortality and heart failure readmission after TAVR.
Using the STS/ACC TVT Registry, a nationwide TAVR Registry in the US, we analyzed 15896 propensity-matched patients who underwent TAVR and found that receiving a prescription for a RAS inhibitor at discharge, compared with no prescription, was associated with a reduced risk for mortality ( 12.5% vs 14.9%) and HF readmission (12.0% vs 13.8%).
MedicalResearch.com: What should readers take away from your report?
Response: Prescription for a RAS inhibitor after TAVR may be associated with lower mortality and risk for heart failure readmission.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our finding generates the hypothesis that a RAS inhibitor is a potential medical therapy to improve clinical outcomes in patients undergoing TAVR.
Due to a retrospective nature, our study has a potential selection bias; therefore, the finding requires further investigation in randomized trials.
MedicalResearch.com: Is there anything else you would like to add?
Response: The STS/ACC TVT Registry is an initiative of the Society of Thoracic Surgeons and the American College of Cardiology Foundation. This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons.
Inohara T, Manandhar P, Kosinski AS, et al. Association of Renin-Angiotensin Inhibitor Treatment With Mortality and Heart Failure Readmission in Patients With Transcatheter Aortic Valve Replacement. JAMA.2018;320(21):2231–2241. doi:10.1001/jama.2018.18077
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