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Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement
Chetan P Huded1, Lillian R Benck2, Neil J Stone3
1Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Insights
High-intensity statin therapy significantly improves survival after transcatheter aortic valve replacement (TAVR). This dose-dependent effect was observed over two years, suggesting statins are crucial for long-term outcomes in TAVR patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Statin therapy improves survival in high-risk cardiovascular patients.
- The effect of statin therapy on outcomes after transcatheter aortic valve replacement (TAVR) is not well-established.
Purpose of the Study:
- To investigate the association between statin therapy intensity and outcomes following TAVR.
Main Methods:
- Retrospective review of 294 consecutive TAVR cases.
- Patients categorized by statin intensity: high (atorvastatin 40-80mg, rosuvastatin 20-40mg), low/moderate, or none.
- Outcomes assessed: post-TAVR adverse events, 30-day mortality, and overall survival up to 2 years.
Main Results:
- No significant association between statin use and immediate post-TAVR adverse events (stroke, MI, AKI, mortality).
- Two-year survival rates: 83% (high-intensity statin), 70% (low/moderate), 57% (no statin).
- High-intensity statin therapy was linked to a 64% reduction in all-cause mortality (HR 0.36, p=0.029) compared to no statin.
Conclusions:
- Statin therapy is associated with improved overall survival after TAVR.
- The survival benefit appears to be dose-dependent, with high-intensity statins showing the most significant improvement.
Abstract:
Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy in patients treated with transcatheter 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 to 80 mg/day or rosuvastatin 20 to 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) were 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% CI 0.14 to 0.90, p = 0.029) compared with no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose-dependent manner.