Optimal Medical Therapy Following Transcatheter Aortic Valve Implantation
Section snippets
Methods
We retrospectively reviewed medical records of consecutive patients with native severe AS who underwent TAVI at Cedars-Sinai Medical center from January 2013 to November 2017 and included in our TAVI database. We excluded patients if they (1) died during the index hospitalization, (2) were discharged against medical advice, (3) were referred to other hospitals or hospice care, (4) had a contraindication for BB or RASi, or (5) if the data of medication at discharge was missing. The remaining
Results
We identified 1756 consecutive patients with native severe AS who underwent TAVI during the study period and excluded 72 patients who met the exclusion criteria. The remaining 1,684 patients constituted our study population, which was categorized based on the status of BB and RASi at discharge as no-treatment group in 415 (25%), BB alone group in 462 (27%), RASi alone group in 349 (21%), and combination group in 458 (27%) patients. The distribution of patients from baseline to 1-year follow-up
Discussion
The main findings of this study are as follows: (1) Compared with patients with no treatment, RASi prescription at discharge was associated with lower composite outcome of all-cause mortality and HHF. This association was not significant for BB; (2) Combination therapy with RASi and BB did not add any significant benefits over RASi alone; (3) These effects were independent of LVEF and were similar even in patients with reduced LV systolic function (Figure 3).
Long-standing AS can lead to
Authors’ Contributions
Danon Kaewkes: Conceptualization, Methodology, Formal analysis, Investigation, Writing - Original Draft. Tomoki Ochiai: Conceptualization, Methodology, Writing - Review & Editing. Nir Flint: Conceptualization, Writing - Review & Editing. Vivek Patel: Investigation, Writing - Review & Editing. Sahar Mahani: Investigation, Writing - Review & Editing. Isic Kim: Investigation, Writing - Review & Editing. Dhairya Patel: Writing - Review & Editing. Tracy Salseth: Writing - Review & Editing. Michelle
Disclosures
Dr. Makkar has received grant support from Edwards Lifesciences Corporation; is a consultant for Abbott Vascular, Cordis, and Medtronic, and holds equity in Entourage Medical. Dr. Chakravarty is a consultant, proctor, and speaker for Edwards Lifesciences and Medtronic; he is a consultant for Abbott Lifesciences, and he is a consultant and speaker for Boston Scientific. Other authors have no conflicts of interest to disclose.
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