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Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement.

Publication ,  Journal Article
Peri-Okonny, PA; Liu, Y; Malaisrie, SC; Huded, CP; Kapadia, S; Thourani, VH; Kodali, SK; Webb, J; McAndrew, TC; Leon, MB; Cohen, DJ; Arnold, SV
Published in: J Am Heart Assoc
April 16, 2019

Background Statins may reduce mortality after transcatheter aortic valve replacement (TAVR) through prevention of atherosclerotic events or pleiotropic effects. However, the competing mortality risks in TAVR patients may dilute any positive effect of statins. We sought to understand the association of statin use with post-TAVR mortality. Methods and Results We included high- or intermediate-surgical risk patients who underwent TAVR as a part of the PARTNER (Placement of Aortic Transcatheter Valves) II and Sapien 3 trials and registries. Outcomes included 2-year all-cause, cardiovascular, and noncardiovascular mortality. We used propensity score matching to generate matched pairs between those discharged on a statin and those not on a statin after TAVR. Bias was explored with falsification end points (urinary infection, hip fracture). Among 3956 patients who underwent TAVR, we matched 626 patients on a statin with 626 patients not on a statin at discharge. Among matched patients, statin use was associated with lower risk of all-cause (hazard ratio [HR] 0.65, 95% CI 0.49-0.87, P=0.001), cardiovascular (HR 0.66, 95% CI 0.46-0.96, P=0.030), and noncardiovascular mortality (HR 0.64, 95% CI 0.44-0.99, P=0.045) compared with no statin use. The survival curves diverged within 3 months and continued to separate over a median follow-up of 2.1 years. The falsification end points were similar among groups (urinary infection, P=0.66; hip fracture, P=0.64). Conclusions In an observational, propensity-matched analysis of TAVR patients, statin use was associated with lower rates of cardiovascular and noncardiovascular mortality compared with no statin use. Given the early emergence of the apparent protective effect of statins, this result may be driven either by pleiotropic effects or by residual confounding despite propensity-matching methodology.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

April 16, 2019

Volume

8

Issue

8

Start / End Page

e011529

Location

England

Related Subject Headings

  • Transcatheter Aortic Valve Replacement
  • Registries
  • Protective Factors
  • Propensity Score
  • Postoperative Care
  • Mortality
  • Male
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Follow-Up Studies
 

Citation

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Peri-Okonny, P. A., Liu, Y., Malaisrie, S. C., Huded, C. P., Kapadia, S., Thourani, V. H., … Arnold, S. V. (2019). Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement. J Am Heart Assoc, 8(8), e011529. https://doi.org/10.1161/JAHA.118.011529
Peri-Okonny, Poghni A., Yangbo Liu, S Chris Malaisrie, Chetan P. Huded, Samir Kapadia, Vinod H. Thourani, Susheel K. Kodali, et al. “Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement.J Am Heart Assoc 8, no. 8 (April 16, 2019): e011529. https://doi.org/10.1161/JAHA.118.011529.
Peri-Okonny PA, Liu Y, Malaisrie SC, Huded CP, Kapadia S, Thourani VH, et al. Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement. J Am Heart Assoc. 2019 Apr 16;8(8):e011529.
Peri-Okonny, Poghni A., et al. “Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement.J Am Heart Assoc, vol. 8, no. 8, Apr. 2019, p. e011529. Pubmed, doi:10.1161/JAHA.118.011529.
Peri-Okonny PA, Liu Y, Malaisrie SC, Huded CP, Kapadia S, Thourani VH, Kodali SK, Webb J, McAndrew TC, Leon MB, Cohen DJ, Arnold SV. Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement. J Am Heart Assoc. 2019 Apr 16;8(8):e011529.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

April 16, 2019

Volume

8

Issue

8

Start / End Page

e011529

Location

England

Related Subject Headings

  • Transcatheter Aortic Valve Replacement
  • Registries
  • Protective Factors
  • Propensity Score
  • Postoperative Care
  • Mortality
  • Male
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Follow-Up Studies