Statins are linked to better survival after TAVI across the oldest ages,: analysis from the multicenter TAVI registry
N Takahashi, S Doi, H Iwata, T Otsuka, S Okazaki, R Higuchi, I Takamisawa, M Ishiyama, H Tamura, H Yokoyama, M Fukutomi, S Takanashi, M Saji, M Tabata, T MinaminoAbstract
Background
Statins have been shown to be linked to improved survival after transcatheter aortic valve implantation (TAVI). However, age-specific effects of statins are unclear. Therefore, the present analysis assessed the association between statin use at TAVI and 5-year mortality across age.
Methods
We retrospectively analyzed the prospective, multicenter-TAVI registry (n=5,797). Exposure was any statin at the time of TAVI. The primary outcome was all-cause mortality until 5 years since TAVI. Unadjusted survival was compared by Kaplan–Meier with log-rank testing. Multivariable Cox models estimated adjusted hazard ratios (aHRs) for statin use across continuous age using restricted cubic splines, adjusting for sex, diabetes, atherosclerotic cardiovascular disease (ASCVD), renin–angiotensin system inhibitor (RASI), and renal function; age-specific effects were displayed as aHRs referenced to 100 years.
Results
Statins were used in 52.7% of patients, who were more often complicated by diabetes and ASCVD. Statin use was associated with lower 5-year mortality overall and among patients aged ≥90 years (log-rank p=0.00325) (Figure A). In adjusted spline analyses, the aHR for statins was consistently <1 across most of the age range, with a sustained association between ages 65 and 100 years, indicating lower mortality among statin users despite greater baseline comorbidity (Figure B).
Conclusions
In this large contemporary TAVI registry, statin use at TAVI was associated with reduced 5-year mortality across nearly the entire age spectrum, including the very elderly. These data support considering routine statin therapy in TAVI recipients when clinically appropriate.Figure AFigure B