Meta-analysis of impact of renin-angiotensin system inhibitors on survival after transcatheter aortic valve implantation.

Abstract

INTRODUCTION\nTo determine whether renin-angiotensin system inhibitor (RASI) prescription is associated with better survival after transcatheter aortic valve implantation (TAVI), we performed the first meta-analysis of currently available studies.\n\n\nEVIDENCE ACQUISITION\nTo identify all studies reporting impact of RASI prescription on survival after TAVI, we searched PubMed, Web of Science, and Google Scholar through October 2019 We extracted adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence interval (CIs) of midterm (up to ≥6-month) allcause for RASI prescription from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random-effects model.\n\n\nEVIDENCE SYNTHESIS\nWe identified 13 eligible studies with a total of 26,132 TAVI patients and included them in the present meta-analysis. None was a randomized controlled trial, 5 were observational studies comparing patients with versus without RASI prescription (including 3 propensity score matched studies), and 8 were observational studies investigating RASI prescription as one of covariates. The primary meta-analysis of all studies demonstrated that RASI prescription was associated with significantly lower midterm mortality (HR, 0.83; 95% CI, 0.76 to 0.92; P = 0.0002). Although we identified significant funnel plot asymmetry (P = 0.036 by the rank correlation test) suggesting publication bias, correcting for it using the trim-and-fill method did not substantially alter the result favoring RASI prescription (corrected HR, 0.85; 95% CI, 0.76 to 0.95; P = 0.004).\n\n\nCONCLUSIONS\nRASI prescription may be associated with better midterm survival after TAVI.