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