Abstract 19515: Statin Use is Associated with Reduced All-Cause Mortality Following Bioprosthetic Heart Valve Implantation

Abstract

Objective: This study examined the impact of statin use on clinical outcomes in patients undergoing bioprosthetic heart valve (BHV) implantation. Background: The medical management of patients undergoing BHV implantation is primarily directed at the management of co-morbid conditions. The anti-atherogenic and anti-inflammatory effects of statin use may contribute to improved clinical outcomes following BHV implantation. Methods: A retrospective analysis of patients (n=1957) undergoing aortic (n=1609) and mitral (n=436) BHV replacement with available data on statin use from 2004 to 2013 was performed. All-cause mortality was assessed using the Social Security Death Index. Association of baseline characteristics and statin use during follow-up with the incidence of events was assessed using a time-dependent covariate Cox regression model. Results: Follow-up was complete in 100% of patients. Total follow-up time was 3.9 ± 2.4 years during which death occurred in 10% of patients. Pre-discharge statin use was not significantly associated with mortality at 30 days or medium-term follow-up. After adjustment for covariates, post-BHV implantation use of statins was associated with a significant reduction in the risk of all-cause mortality in the entire cohort: HR=0.55, 95% CI: 0.40-0.74, P<0.001. In addition, post-BHV statin use was associated with a decreased risk of all-cause mortality in the aortic valve replacement subgroup: HR=0.59, 95% CI: 0.42-0.84, P=0.003, and mitral valve replacement subgroup: HR=0.30, 95% CI: 0.17-0.54, P<0.001. After exclusion of patients with known CAD (43% of the cohort), post-BHV use of statin therapy remained associated with a lower risk of death: HR=0.51, 95% CI: 0.33-0.80, P=0.004. Conclusion: Statin treatment is associated with a significant reduction in medium-term all-cause mortality in patients with and without CAD undergoing aortic and mitral BHV implantation.