Statins post-TAVR: mortality rates decrease vs no statins

  • Peri-Okonny PA & al.
  • J Am Heart Assoc
  • 16 Apr 2019

  • International Clinical Digest
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Takeaway

  • Statins after transcatheter aortic valve replacement (TAVR) seem to reduce mortality compared with nonuse of statins post-TAVR.
  • However, the authors are more urgent than usual about the potential for confounding, especially given the unexpectedly early emergency of a protective effect of statins.

Why this matters

  • Statins might be effective as adjunctive therapy post-TAVR.

Key results

  • Vs no statins after TAVR, post-TAVR statin use was tied to reduced mortality (HRs; 95% CIs):
    • All-cause: 0.65 (0.49‐0.87; P=.001).
    • Cardiovascular: 0.66 (0.46‐0.96; P=.030).
    • Noncardiovascular: 0.64 (0.44‐0.99; P=.045), likely because of lower infection and cancer rates.
  • An early effect was seen, as early as 3 months post-TAVR, of a split between mortality outcomes with statins vs no-statins that widened over 2.1 years.
  • At 2 years, rates of myocardial infarction, stroke, and bleeding were similar between the 2 groups.

Study design

  • Patients having TAVR in PARTNER and Sapien 3 trial registries, in 2 propensity-score-matched groups (626 per group), on statin or not.
  • Bias checked using 2 falsification endpoints (urinary tract infection, hip fracture).
  • Outcomes: 2-year mortality.
  • Funding: Reported as self-funded.

Limitations

  • Residual confounding possible.
  • No causality established.
  • Early mortality benefit is odd, the authors say.