Association Between Use of Renin-Angiotensin System Inhibitors and Cardiovascular Outcomes Following Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

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Abstract Background Aortic stenosis (AS) carries a high mortality risk if left untreated. Transcatheter aortic valve implantation (TAVI) has emerged as a primary treatment modality for many patients with severe AS. Observational data suggest that renin-angiotensin system (RAS) inhibitor use following TAVI are associated with lower risk, but with divergent reported effects and limited statistical power for specific cardiovascular outcome. This study aimed to assess the association between RAS inhibitor use and clinical outcomes after TAVI. Methods A systematic literature search was conducted in EMBASE and PubMed. Eligible studies included those reporting on RAS inhibitor use in TAVI populations. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, myocardial infarction (MI), cerebrovascular events, and heart failure (HF) hospitalization. Results Nine observational studies including 36,015 patients were included. RAS inhibitor use was associated with lower odds of all-cause mortality (OR 0.74, 95% CI 0.70– 0.78), cardiovascular mortality (OR 0.62, 95% CI 0.55–0.72), cerebrovascular events (OR 0.59, 95% CI 0.47–0.74), and HF hospitalization (OR 0.84, 95% CI 0.77–0.92). No clear association was observed for MI (OR 0.95, 95% CI 0.59–1.53). Conclusions RAS inhibitor use was associated with favorable clinical outcomes following TAVI. However, these findings are based on observational data, which are subject to residual confounding. Randomized controlled trials are needed to clarify the clinical utility of RAS inhibitors in this setting.

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