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Statin Therapy and inflammation Following Transcatheter Aortic Valve Implantation

Ilan Merdler*, Zach Rozenbaum, Ariel Finkelstein, Yaron Arbel, Shmuel Banai, Samuel Bazan, Amir Halkin, Yacov Shacham, Sophia Zhitomirsky, Sydney Horen and Arie Stenvil

Background: Increased inflammatory responses following aortic valve replacement are linked to higher post procedural mortality. The aim of the present analysis was to assess the impact of statin therapy on inflammatory modulation and procedural outcomes following transcatheter aortic valve implantation (TAVI).

Methods: We performed a retrospective analysis of TAVI patients stratified by pre-admission statinintensity, for which C-reactive protein (CRP) was available at baseline and up to 10 hours following the procedure. C-reactive protein velocity was defined as the change in CRP concentration divided by the change in time between the two measurements.

Results: Included were 364 patients at a mean age of 82 ± 6. High intensity statins patients were younger (80 ± 7 years of age vs. 83 ± 5 vs. 83 ± 6, p=0.001), were more likely to have a history of ischemic heart disease (73.1% vs. 60.3% vs. 52.4%, p=0.013) and lower low density cholesterol levels (75.2 vs. 74.3 vs. 91.4 mg/dl, p<0.001), as compared to the low-medium intensity statins and no statins patients, respectively. Non-significant lower values of CRP velocity (2.84 vs. 7.05 vs. 20.59, p=0.698) and post-procedure CRP were observed (8.16 vs. 10.38 vs. 12.85, p=0.31) for the high intensity statins versus the two other groups. A nonsignificant trend (p log-rank=0.666) for reduced long term mortality was observed for the high intensity group.

Conclusion: High intensity statin therapy may be associated with a reduced inflammatory response following TAVI. Larger scale studies are needed to confirm this hypothesis.