Divergent Role of Statin Use and Intensity in Patients Undergoing Transcatheter Aortic Valve Replacement

Acute kidney injury (AKI) and reduced glomerular filtration rate (GFR) are common complications following transcatheter aortic valve replacement (TAVR). Statins may exert renoprotective effects; however, the impact of statin intensity on renal outcomes remains uncertain. This study aimed to evaluate the association between preprocedural statin use and intensity with short-term renal outcomes after TAVR.

We conducted a retrospective longitudinal cohort study including 810 consecutive patients undergoing TAVR at Kaplan Medical Center between January 2014 and August 2024. Patients were stratified by statin use (users vs. non-users) and statin intensity (high-intensity statins [HISs] vs. low-to-moderate-intensity statins). The primary outcome was 30-day change in estimated GFR (eGFR), categorized as improved, stable, or deteriorated. The secondary outcome was 30-day incidence of AKI. Multinomial logistic regression and Cox proportional hazards models were used, adjusted for baseline and procedural confounders.

Statin use was associated with an increased probability of GFR improvement (average marginal effect [AME], 20.7%; 95% CI, 12.3%-29.1%; p < 0.001) and a reduced risk of AKI (adjusted hazard ratio [HR], 0.53; 95% CI, 0.31-0.88; p = 0.015). In contrast, HIS therapy was associated with a higher risk of GFR deterioration (AME, 10.3%; 95% CI, 2.9%-17.8%; p = 0.006) and increased AKI incidence (adjusted HR, 2.85; 95% CI, 1.52-5.34; p = 0.001), particularly in the early postoperative period.

Statin therapy is associated with improved short-term renal outcomes after TAVR. However, HISs may increase the risk of renal deterioration and AKI. These findings support individualized statin intensity strategies in the periprocedural period to balance cardiovascular benefit and renal safety.