“…Our study indicates that statins reduce all-cause mortality in TAVI patients. Most high-quality studies 9,10,16,17,21-23 of the included studies in our meta-analysis shared the same result that statin treatment significantly reduces mortality in TAVI patients. This beneficial effect was observed in 2-year, 3-year, and 5-year follow-ups.…”
Section: Discussionsupporting
confidence: 60%
“…The result of analysis for twelve studies 9-11,15-19,21,23,25,26 that reported HR, also favored statin therapy (HR = .78, 95% CI 0.64-.93, P = .0063; I 2 = 53.2%, Q value = 23.51, P = .0149) (Figure 4). Figure 4.Comparison of the impact of statin vs no statin therapy on all-cause mortality in studies that reported hazard ratio.…”
Section: Resultsmentioning
confidence: 95%
“…The sensitivity analysis of the 9 high-quality studies 9-11,16,17,21-23,28,29 with low risk of bias indicated a lower risk of all-cause mortality in patients who received statin therapy (HR = .75, 95% CI 0.66-.85, P < .0001; I 2 = 55.3%, Q value = 17.90, P = .0220) (Figure 3). However, the analysis for low-quality studies did not show any beneficial effect for statin therapy (HR = .92, 95% CI 0.70–1.20, P = .52; I 2 = 29.0%, Q value = 9.86, P = .1969).Figure 3.Comparison of the impact of statin vs no statin therapy on all-cause mortality among high-quality and low-quality studies.…”
Section: Resultsmentioning
confidence: 99%
“…Full texts of 48 possible eligible articles were reviewed. Finally, after a thorough full-text review, 17 [9][10][11][15][16][17][18][19][20][21][22][23][24][25][26][27][28] articles with 21 380 patients were included in the metaanalysis. The flow chart presenting the selection of the articles is shown in (Figure 1).…”
While TAVI is widely used, optimal medical therapy to reduce the mortality rate after transcatheter aortic valve implantation (TAVI) is still unclear. We performed a systematic review and meta-analysis to evaluate the impact of statins on mortality following TAVI. Present systematic review of the literature was performed using Medline, Embase, Scopus, and Web of Science; all studies reported all-cause mortality in patients who underwent TAVI and received or did not receive statin therapy. Data were analyzed using random-effects models. Seventeen articles (21 380 patients) were included in the meta-analysis. Statin therapy was associated with a reduction of all-cause mortality (Hazard ratio [HR] = .78, 95% Confidence interval [CI] .68–.89, P < .001). Moderate between-study heterogeneity was observed (I2 = 45.2). High-intensity statin therapy was more effective than low or moderate intensity statin therapy in reduction of all-cause mortality (Risk ratio [RR] = .62, 95% CI 0.45–.85, P = .003, I2 = .0). Statin therapy could reduce the mid-term all-cause mortality rate following TAVI. However, all included studies were observational and, therefore, randomized controlled trials are still needed to assess the effect of statin therapy on mortality after TAVI.
“…Our study indicates that statins reduce all-cause mortality in TAVI patients. Most high-quality studies 9,10,16,17,21-23 of the included studies in our meta-analysis shared the same result that statin treatment significantly reduces mortality in TAVI patients. This beneficial effect was observed in 2-year, 3-year, and 5-year follow-ups.…”
Section: Discussionsupporting
confidence: 60%
“…The result of analysis for twelve studies 9-11,15-19,21,23,25,26 that reported HR, also favored statin therapy (HR = .78, 95% CI 0.64-.93, P = .0063; I 2 = 53.2%, Q value = 23.51, P = .0149) (Figure 4). Figure 4.Comparison of the impact of statin vs no statin therapy on all-cause mortality in studies that reported hazard ratio.…”
Section: Resultsmentioning
confidence: 95%
“…The sensitivity analysis of the 9 high-quality studies 9-11,16,17,21-23,28,29 with low risk of bias indicated a lower risk of all-cause mortality in patients who received statin therapy (HR = .75, 95% CI 0.66-.85, P < .0001; I 2 = 55.3%, Q value = 17.90, P = .0220) (Figure 3). However, the analysis for low-quality studies did not show any beneficial effect for statin therapy (HR = .92, 95% CI 0.70–1.20, P = .52; I 2 = 29.0%, Q value = 9.86, P = .1969).Figure 3.Comparison of the impact of statin vs no statin therapy on all-cause mortality among high-quality and low-quality studies.…”
Section: Resultsmentioning
confidence: 99%
“…Full texts of 48 possible eligible articles were reviewed. Finally, after a thorough full-text review, 17 [9][10][11][15][16][17][18][19][20][21][22][23][24][25][26][27][28] articles with 21 380 patients were included in the metaanalysis. The flow chart presenting the selection of the articles is shown in (Figure 1).…”
While TAVI is widely used, optimal medical therapy to reduce the mortality rate after transcatheter aortic valve implantation (TAVI) is still unclear. We performed a systematic review and meta-analysis to evaluate the impact of statins on mortality following TAVI. Present systematic review of the literature was performed using Medline, Embase, Scopus, and Web of Science; all studies reported all-cause mortality in patients who underwent TAVI and received or did not receive statin therapy. Data were analyzed using random-effects models. Seventeen articles (21 380 patients) were included in the meta-analysis. Statin therapy was associated with a reduction of all-cause mortality (Hazard ratio [HR] = .78, 95% Confidence interval [CI] .68–.89, P < .001). Moderate between-study heterogeneity was observed (I2 = 45.2). High-intensity statin therapy was more effective than low or moderate intensity statin therapy in reduction of all-cause mortality (Risk ratio [RR] = .62, 95% CI 0.45–.85, P = .003, I2 = .0). Statin therapy could reduce the mid-term all-cause mortality rate following TAVI. However, all included studies were observational and, therefore, randomized controlled trials are still needed to assess the effect of statin therapy on mortality after TAVI.
“…Peri-Okonny et al 7 demonstrated that statin therapy was associated with reductions in 2-year all-cause (aHR 0.65, 95% CI 0.49 to 0.87, p=0.001), cardiovascular (aHR 0.66, 95% CI 0.46 to 0.96, p=0.030) and non-cardiovascular (aHR 0.64, 95% CI 0.44 to 0.99, p=0.045) mortality compared with no statin therapy, with a large cohort using PARTNER II and Sapien 3 clinical trials or associated registries (626 pairs of patients after PS matching). Merdler et al 15 showed that high-intensity statin therapy was associated with a reduction in mortality after TAVI (median follow-up period: 2.5 years) using data of 1238 cases from a single-centre registry (aHR 0.59, 95% CI 0.37 to 0.96, p=0.03). Huded et al 16 also showed that high-intensity statin therapy was associated with a reduction in all-cause mortality (mean survival: 3.9 years) based on 294 cases (aHR 0.36, 95% CI 0.14 to 0.90, p=0.029).…”
ObjectiveData on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients.DesignObservational study.SettingThis study included patients with AS from a Japanese multicentre registry who underwent TAVI.ParticipantsThe overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%–9.50%), the Euro II score was 3.74% (IQR 2.34%–6.02%) and the Clinical Frailty Scale score was 3.9±1.2.InterventionsWe classified patients based on statin at admission and identified 936 matched pairs after propensity score matching.Primary and secondary outcome measuresThe outcomes were all-cause and cardiovascular mortality.ResultsThe median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01).ConclusionsStatin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.Trial registration numberUMIN000020423.
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