The effect of achieving guideline-based target low-density lipoprotein cholesterol levels on mortality in transcatheter aortic valve implantation patients with coronary artery disease

Objectives: The aim of this retrospective study was to evaluate the effects of bringing low-density lipoprotein cholesterol (LDL-C) values to levels in line with guideline recommendations on long-term mortality in patients with a known history of coronary artery disease (CAD), undergoing transcatheter aortic valve implantation (TAVI), and long-term pre-treatment with statins. Methods: This is a retrospective and observational study of patients undergoing TAVI at a tertiary heart center with a history of CAD and long-term statin therapy. Ninety-nine patients were included in the study. The relationship between LDL-C levels in accordance with the guidelines and 5-year mortality was determined by regression analysis. Results: When the study population was divided into 2 groups with and without 5-year mortality, LDL-C values were found to be significantly higher in the mortality group (120 mg/dL vs. 93.9 mg/dL, p < 0.001). Parameters associated with the development of 5-year mortality were evaluated with univariate and multivariate logistic regression analysis. LDL-C ≥ 100 mg/dL (OR: 6.59, 95% CI: 2.17-20.01) and LDL-C ≥ 70 mg/dL (OR:3.88, 95% CI: 1.16-12.93) parameters were determined as independent predictors of mortality independent of other parameters. Conclusions: The most important result obtained in this study is that achieving the LDL-C level targets specified in the guidelines significantly reduces the in-hospital and 5-year mortality rates in patients with a previous history of CAD and statin use and undergoing TAVI. Although all patients included in the study used statins, the mortality rate was significantly higher in patients who did not reach the target LDL-C value.

Keywords:

Transcatheter aortic valve implantation, low-density lipoprotein cholesterol statin, coronary artery disease,

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1. Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart 2013;99:396-400.
2. Lindman BR, Clavel MA, Mathieu P, Lung B, Lancelotti P, Pibarot P, et al. Calcific aortic stenosis. Nat Rev Dis Primers 2016;2:16006.
3. Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart 2013;99:396-400.
4. Collas VM, Paelinck BP, Rodrigus IE, Vrints CJ, Van Craenenbroeck EM, Bosmans JM. Red cell distribution width improves the prediction of prognosis after transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2016;49:471-7.
5. López-Otero D, Trillo-Nouche R, Gude F, Cid-Álvarez B, Ocaranza-Sanchez R, Alvarez MS, et al. Pro B-type natriuretic peptide plasma value: a new criterion for the prediction of short- and long-term outcomes after transcatheter aortic valve implantation. Int J Cardiol 2013;168:1264-8.
6. Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, et al. Impact of frailty on mortality after transcatheter aortic valve implantation. Am Heart J 2017;185:52-8.
7. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999;341:142-7.
8. Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373:956-66.
9. Otto CM, Kuusisto J, Reichenbach DD, Gown AM, O’Brien KD. Characterization of the early lesion of “degenerative” valvular aortic stenosis. Histological and immunohistochemical studies. Circulation 1994;90:844-53.
10. Otto CM. Calcific aortic stenosis - time to look more closely at the valve. N Engl J Med 2008;359:1395-8.
11. Exadactylos N, Sugrue DD, Oakley CM. Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. Br Heart J 1984;51:121-4.
12. Lombard JT, Selzer A. Valvular aortic stenosis. A clinical and hemodynamic profile of patients. Ann Intern Med 1987;106:292-8.
13. Son JW, Koh KK, Ahn JY, Jin DK, Park GS, Kim DS, et al. Effects of statin on plaque stability and thrombogenicity in hypercholesterolemic patients with coronary artery disease. Int J Cardiol 2003;88:77-82.
14. Yashima F, Hara M, Inohara T, Jinzaki M, Shimizu H, Fukuda K, et al. Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry. BMJ Open 2021;11:e044319.
15. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670-81.
16. Kappetein AP, Head SJ, Généreux P, Piazza N, Blackstone EH, Brott TG, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg 2012;42:S45-60.
17. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70.
18. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes- 2018. Diabetes Care 2018;41:S13-27.
19. Peri-Okonny PA, Liu Y, Malaisrie SC, Huded CP, Kapadia S, Thourani VH, et al. Association of statin use and mortality after transcatheter aortic valve replacement. J Am Heart Assoc 2019;8:e011529.
20. Merdler I, Rozenbaum Z, Finkelstein A, Arbel Y, Banai S, Bazan S, et al. Effect of statin therapy and long-term mortality following transcatheter aortic valve implantation. Am J Cardiol 2019;123:1978-82.
21. Huded CP, Benck LR, Stone NJ, Sweis RN, Ricciardi MJ, Malaisrie SC, et al. Relation of intensity of statin therapy and outcomes after transcatheter aortic valve replacement. Am J Cardiol 2017;119:1832-8.
22. Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Meta-analysis for impact of statin on mortality after transcatheter aortic valve implantation. Am J Cardiol 2019;124:920-5.
23. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111-88.
24. van Nieuwkerk AC, Santos RB, Mata RB, Tchétché D, de Brito Jr FS, Barbanti M, et al. Diabetes mellitus in transfemoral transcatheter aortic valve implantation: a propensity matched analysis. Cardiovasc Diabetol 2022;21:246.