Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement
Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy among patients treated with trans-catheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary...
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| Veröffentlicht in: | The American journal of cardiology 2017-06, Vol.119 (11), p.1832-1838 |
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| container_title | The American journal of cardiology |
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| creator | Huded, Chetan P., MD MSc Benck, Lillian R., MD MPH Stone, Neil J., MD Sweis, Ranya N., MD MSc Ricciardi, Mark J., MD Malaisrie, S. Chris, MD Davidson, Charles J., MD Flaherty, James D., MD |
| description | Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy among patients treated with trans-catheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary care medical center. We defined high intensity statin therapy as atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day. Study outcomes included post-TAVR adverse events, 30-day mortality, and overall survival. At the time of TAVR, 14% (n=41) were on high intensity statin therapy, 59% (n=173) on low or moderate intensity statin therapy, and 27% (n=80) were not on statin therapy. There was no association between statin therapy and the rate of post-TAVR stroke, myocardial infarction, acute kidney injury, in-hospital mortality, or 30-day mortality. At 2 years, 83% of patients in the high intensity statin group were alive, 70% in the low/moderate intensity statin group were alive, and 57% in the no statin group were alive (log-rank P = 0.016). In a risk-adjusted model, high intensity statin therapy was associated with a 64% reduction in all-cause mortality (hazard ratio 0.36, 95% confidence interval 0.14 – 0.90, P=0.029) when compared to no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose dependent manner. |
| doi_str_mv | 10.1016/j.amjcard.2017.02.042 |
| format | Article |
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Chris, MD ; Davidson, Charles J., MD ; Flaherty, James D., MD</creator><creatorcontrib>Huded, Chetan P., MD MSc ; Benck, Lillian R., MD MPH ; Stone, Neil J., MD ; Sweis, Ranya N., MD MSc ; Ricciardi, Mark J., MD ; Malaisrie, S. Chris, MD ; Davidson, Charles J., MD ; Flaherty, James D., MD</creatorcontrib><description>Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy among patients treated with trans-catheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary care medical center. We defined high intensity statin therapy as atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day. Study outcomes included post-TAVR adverse events, 30-day mortality, and overall survival. At the time of TAVR, 14% (n=41) were on high intensity statin therapy, 59% (n=173) on low or moderate intensity statin therapy, and 27% (n=80) were not on statin therapy. There was no association between statin therapy and the rate of post-TAVR stroke, myocardial infarction, acute kidney injury, in-hospital mortality, or 30-day mortality. At 2 years, 83% of patients in the high intensity statin group were alive, 70% in the low/moderate intensity statin group were alive, and 57% in the no statin group were alive (log-rank P = 0.016). In a risk-adjusted model, high intensity statin therapy was associated with a 64% reduction in all-cause mortality (hazard ratio 0.36, 95% confidence interval 0.14 – 0.90, P=0.029) when compared to no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose dependent manner.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.02.042</identifier><identifier>PMID: 28395888</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged, 80 and over ; Anticoagulants ; Aortic valve ; Aortic Valve - surgery ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - surgery ; Atorvastatin ; Cardiovascular ; Cardiovascular disease ; Cardiovascular diseases ; Cause of Death - trends ; Cerebral infarction ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Health care facilities ; Health risk assessment ; Health risks ; Heart Valve Prosthesis ; Hospital Mortality - trends ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage ; Incidence ; Kidneys ; Male ; Mortality ; Myocardial infarction ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Registries ; Retrospective Studies ; Risk Factors ; Statins ; Stroke ; Survival ; Survival Rate - trends ; Therapy ; Time Factors ; Transcatheter Aortic Valve Replacement - adverse effects ; Treatment Outcome ; United States - epidemiology</subject><ispartof>The American journal of cardiology, 2017-06, Vol.119 (11), p.1832-1838</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Jun 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-a53da28b5b1a2eceaf99e6b86a580474147f2f16ad19acc892e6415a92569c273</citedby><cites>FETCH-LOGICAL-c448t-a53da28b5b1a2eceaf99e6b86a580474147f2f16ad19acc892e6415a92569c273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1898093241?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994,64384,64386,64388,72240</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28395888$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huded, Chetan P., MD MSc</creatorcontrib><creatorcontrib>Benck, Lillian R., MD MPH</creatorcontrib><creatorcontrib>Stone, Neil J., MD</creatorcontrib><creatorcontrib>Sweis, Ranya N., MD MSc</creatorcontrib><creatorcontrib>Ricciardi, Mark J., MD</creatorcontrib><creatorcontrib>Malaisrie, S. Chris, MD</creatorcontrib><creatorcontrib>Davidson, Charles J., MD</creatorcontrib><creatorcontrib>Flaherty, James D., MD</creatorcontrib><title>Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy among patients treated with trans-catheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary care medical center. We defined high intensity statin therapy as atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day. Study outcomes included post-TAVR adverse events, 30-day mortality, and overall survival. At the time of TAVR, 14% (n=41) were on high intensity statin therapy, 59% (n=173) on low or moderate intensity statin therapy, and 27% (n=80) were not on statin therapy. There was no association between statin therapy and the rate of post-TAVR stroke, myocardial infarction, acute kidney injury, in-hospital mortality, or 30-day mortality. At 2 years, 83% of patients in the high intensity statin group were alive, 70% in the low/moderate intensity statin group were alive, and 57% in the no statin group were alive (log-rank P = 0.016). In a risk-adjusted model, high intensity statin therapy was associated with a 64% reduction in all-cause mortality (hazard ratio 0.36, 95% confidence interval 0.14 – 0.90, P=0.029) when compared to no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose dependent manner.</description><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Aortic valve</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Atorvastatin</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cause of Death - trends</subject><subject>Cerebral infarction</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health care facilities</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Heart Valve Prosthesis</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</subject><subject>Incidence</subject><subject>Kidneys</subject><subject>Male</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Statins</subject><subject>Stroke</subject><subject>Survival</subject><subject>Survival Rate - trends</subject><subject>Therapy</subject><subject>Time Factors</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkk9v1DAQxS0EotvCRwBF4tJLFo_zz76AVhWUSpUqtQtXa9aZqA6Js9hOpf32ONoFpF44Wc_6vfF43jD2DvgaONQf-zWOvUHfrgWHZs3FmpfiBVuBbFQOCoqXbMU5F7mCUp2x8xD6JAGq-jU7E7JQlZRyxfCeBox2ctnUZTcukgs2HhbxENO9y7aP5HF_yNC12d0czTRSyDZdJJ9tPbpgMD7SojaTj9ZkP3B4ouye9gMaGsnFN-xVh0Ogt6fzgn3_-mV79S2_vbu-udrc5qYsZcyxKloUclftAAUZwk4pqneyxkrysimhbDrRQY0tKDRGKkF1CRUqUdXKiKa4YJfHuns__ZopRD3aYGgY0NE0Bw1S1k3FlaoT-uEZ2k-zd6m7RCnJVSFKSFR1pIyfQvDU6b23I_qDBq6XDHSvTxnoJQPNhU4ZJN_7U_V5N1L71_Vn6An4fAQojePJktfBWHKGWuvJRN1O9r9PfHpWwQzWWYPDTzpQ-PcbHZJBPyyLsOwBNAUXjSyK35HJrvc</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Huded, Chetan P., MD MSc</creator><creator>Benck, Lillian R., MD MPH</creator><creator>Stone, Neil J., MD</creator><creator>Sweis, Ranya N., MD MSc</creator><creator>Ricciardi, Mark J., MD</creator><creator>Malaisrie, S. Chris, MD</creator><creator>Davidson, Charles J., MD</creator><creator>Flaherty, James D., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement</title><author>Huded, Chetan P., MD MSc ; Benck, Lillian R., MD MPH ; Stone, Neil J., MD ; Sweis, Ranya N., MD MSc ; Ricciardi, Mark J., MD ; Malaisrie, S. Chris, MD ; Davidson, Charles J., MD ; Flaherty, James D., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-a53da28b5b1a2eceaf99e6b86a580474147f2f16ad19acc892e6415a92569c273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Aortic valve</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Atorvastatin</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cause of Death - trends</topic><topic>Cerebral infarction</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health care facilities</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Heart Valve Prosthesis</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</topic><topic>Incidence</topic><topic>Kidneys</topic><topic>Male</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Statins</topic><topic>Stroke</topic><topic>Survival</topic><topic>Survival Rate - trends</topic><topic>Therapy</topic><topic>Time Factors</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huded, Chetan P., MD MSc</creatorcontrib><creatorcontrib>Benck, Lillian R., MD MPH</creatorcontrib><creatorcontrib>Stone, Neil J., MD</creatorcontrib><creatorcontrib>Sweis, Ranya N., MD MSc</creatorcontrib><creatorcontrib>Ricciardi, Mark J., MD</creatorcontrib><creatorcontrib>Malaisrie, S. 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Chris, MD</au><au>Davidson, Charles J., MD</au><au>Flaherty, James D., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>119</volume><issue>11</issue><spage>1832</spage><epage>1838</epage><pages>1832-1838</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy among patients treated with trans-catheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary care medical center. We defined high intensity statin therapy as atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day. Study outcomes included post-TAVR adverse events, 30-day mortality, and overall survival. At the time of TAVR, 14% (n=41) were on high intensity statin therapy, 59% (n=173) on low or moderate intensity statin therapy, and 27% (n=80) were not on statin therapy. There was no association between statin therapy and the rate of post-TAVR stroke, myocardial infarction, acute kidney injury, in-hospital mortality, or 30-day mortality. At 2 years, 83% of patients in the high intensity statin group were alive, 70% in the low/moderate intensity statin group were alive, and 57% in the no statin group were alive (log-rank P = 0.016). In a risk-adjusted model, high intensity statin therapy was associated with a 64% reduction in all-cause mortality (hazard ratio 0.36, 95% confidence interval 0.14 – 0.90, P=0.029) when compared to no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose dependent manner.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28395888</pmid><doi>10.1016/j.amjcard.2017.02.042</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged, 80 and over Anticoagulants Aortic valve Aortic Valve - surgery Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Atorvastatin Cardiovascular Cardiovascular disease Cardiovascular diseases Cause of Death - trends Cerebral infarction Dose-Response Relationship, Drug Female Follow-Up Studies Health care facilities Health risk assessment Health risks Heart Valve Prosthesis Hospital Mortality - trends Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Incidence Kidneys Male Mortality Myocardial infarction Patients Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Registries Retrospective Studies Risk Factors Statins Stroke Survival Survival Rate - trends Therapy Time Factors Transcatheter Aortic Valve Replacement - adverse effects Treatment Outcome United States - epidemiology |
| title | Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement |
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