Magne J, et al. - Researchers sought to determine the short- and long-term survival in association with treatment with renin-angiotensin system blockers (RASb) in patients who underwent isolated surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). Although a randomized clinical trial is mandatory to investigate this topic, the findings of this observational study demonstrated an association of the use of RASb with improved long-term outcome after isolated SAVR for severe AS.

Methods

• This study included 508 consecutive patients who had isolated SAVR for severe AS from 01/2005 to 01/2014.

Results

• The reported characteristics of patients with RASb (n=286; 53%) were as follows: these patients were more often female (p=0.039), hypertensive (p<0.0001) and diabetic (p=0.004), with higher body mass index (p<0.0001) and Euroscore II (p=0.025), and lower mean aortic pressure gradient (p=0.011).
• Although both groups had similar 30-day mortality (RASb: 3% vs no RASb 5.8%, p=0.13), but under angiotensin receptor blockers (ARB) vs angiotensin converting enzyme inhibitors (ACEi: 0.7% vs 5.6%, p=0.017), lower mortality was observed.
• A better 8-year survival was noted in patients under RASb vs those without RASb (83±3% vs 52±5%, p<0.0001), corroborated in a propensity score-matched pairs analysis (82±4% vs 50±7%, p<0.0001).
• With respect to different types of RASb, lower mortality was reported among patients under ARB than those under ACEi (87±3% vs 79±4%, p=0.028).
• Findings demonstrated that the use of RASb was associated with improved survival (HR=0.31, 95%CI: 0.20-0.47, p<0.0001), with lower mortality under ARB vs ACEi (HR=0.39, 95%CI: 0.18-0.85, p=0.018) in multivariate analysis.