Association between perioperative statin treatment and short-term clinical outcomes following transcatheter aortic valve implantation: a retrospective cohort study

Geert Lefeber; Lauren Dautzenberg; Wilma Knol; Carla Huijbers; Michiel Voskuil; Adriaan O Kraaijeveld; Marcel Bouvy; Anthonius de Boer; Marielle Emmelot-Vonk; Huiberdina L Koek

doi:10.1136/openhrt-2023-002348

Association between perioperative statin treatment and short-term clinical outcomes following transcatheter aortic valve implantation: a retrospective cohort study

Open Heart. 2023 Oct;10(2):e002348. doi: 10.1136/openhrt-2023-002348.

Affiliations

¹ Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands g.j.lefeber@umcutrecht.nl.
² Department of Geriatric Medicine, Utrecht University, Utrecht, The Netherlands.
³ Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
⁴ Department of Cardiology, UMC, Utrecht, The Netherlands.

Abstract

Background: Studies have found statin treatment to be associated with improved 1-year survival after transcatheter aortic valve implantation (TAVI), suggesting pleiotropic effects of statins on preventing perioperative complications. Statin treatment is not associated with postoperative cardiovascular complications or mortality; however, other postoperative complications have not been investigated.

Aim: To explore whether preoperative statin treatment is associated with a lower short-term risk of mortality, readmission and major postoperative complications in older patients undergoing TAVI.

Methods: A retrospective cohort study including patients aged 65 years and older who had undergone a comprehensive geriatric assessment prior to TAVI between January 2014 and January 2021. The primary outcomes were 90-day mortality, 90-day readmissions and major postoperative complications according to the Clavien-Dindo classification. Multivariable logistic regression was performed with adjustment for potential confounders, namely age, gender, comorbidity, body mass index, smoking, diminished renal function, alcohol use and falls .

Results: This study included 584 patients, of whom 324 (55.5%) were treated with a statin. In the statin treated group, 15 (4.6%) patients died within 90 days of TAVI compared with 10 (3.8%) patients in the non statin group (adjusted OR 1.17; 95% CI 0.51 to 2.70). The number of 90-day readmissions was 39 (12.0%) and 34 (13.1%) (adjusted OR 0.91; 95% CI 0.54 to 1.52), respectively. In the statin treated group, 115 (35.5%) patients experienced a major complication compared with 98 (37.7%) in the non-statin group (adjusted OR 0.95; 95% CI 0.67 to 1.37).

Conclusion: Preoperative statin treatment is not associated with improved short-term outcomes after TAVI. A randomised controlled trial with different statin doses may be warranted to investigate whether initiating statin treatment before TAVI improves both postoperative outcomes and long-term survival.

Keywords: Pharmacology; Pharmacology, Clinical; Transcatheter Aortic Valve Replacement.

MeSH terms

Aged
Aortic Valve Stenosis* / complications
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Postoperative Complications
Retrospective Studies
Risk Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors