Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Aortic stenosis leads to left ventricular remodeling, hypertrophy, and fibrosis, increasing the risk of heart failure. Renin-angiotensin system (RAS) inhibitors may mitigate these adverse effects and improve clinical outcomes. Despite advancements in transcatheter aortic valve replacement (TAVR), substantial mortality, heart failure readmissions, and other complications persist. AIMS: This study aimed to evaluate the impact of RAS inhibitor therapy following TAVR on clinical outcomes. METHODS: We conducted a systematic review and Bayesian meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search of PubMed, Embase, and Cochrane was performed to identify studies comparing RAS inhibitor (RASi) use versus non-use in patients undergoing TAVR for aortic stenosis. Odds ratios (OR) and 95% credible intervals (CrI) were estimated using a Bayesian random-effects model. Between-study heterogeneity was quantified using the posterior distribution of the heterogeneity parameter (τ). Posterior probabilities (PP) of treatment benefit were calculated, with clinically meaningful effects defined as P (OR < 0.8). All analyses were performed using R version 4.5.0. RESULTS: A total of 12 studies comprising 35,988 patients were included, of whom 17,026 (47.3%) received RASi therapy. The mean age ranged from 78.9 to 84.4 years. Post-TAVR RASi use was associated with a 79.4% probability of a clinically relevant reduction in all-cause mortality and a 99.5% probability of a clinically relevant reduction in cardiovascular mortality. There was a 54% probability of a clinically relevant reduction in heart failure hospitalization and a negligible (2.26%) probability of a reduction in the odds of myocardial infarction in the RASi group. CONCLUSIONS: RASi therapy following TAVR is associated with reduced odds of mortality and heart failure readmission.
DOI: 10.1002/ccd.70506
Authors: Vinícius Martins Rodrigues Oliveira, Lucas M. Barbosa, Pedro Antônio de Sousa, Ana Paula Duarte Lima, Maria Antonia Cruz Akabane, Arthur Borges, Edmundo Damiani Bertoli, Elísio Bulhões, Carlos Alexandre Farias, Roberto Mazetto, Paulo Roberto Ferreira Tartuce Filho, Robert Willian Anastácio Alcântara, Tiago Bignoto, Brunna Pileggi, Humberto Graner Moreira, Ludimilla Pereira Tartuce
Institutions: Universidade Federal de Goiás, Universidade Federal de Minas Gerais, Universidade de São Paulo, Instituto do Coração - HCFMUSP, Universidade Federal de Uberlândia, Universidade de Rio Verde, Universidade Federal de Juiz de Fora, Universidade da Amazônia, Universidade Nove de Julho, Universidade do Estado do Amazonas
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7128368697