Impact of Preoperative Diuretics Treatment on Long-Term Clinical Outcomes After Transcatheter Aortic Valve Implantation.

Abstract

Diuretics are used to relieve congestive symptoms in patients with severe aortic stenosis (AS). However, the effect of preprocedural diuretic treatment on long-term outcomes in AS patients who undergoing transcatheter aortic valve implantation (TAVI) remains unclear. We prospectively enrolled 4,903 consecutive AS patients who underwent TAVI in 7 Japanese hospitals between April 2010 and June 2024 and evaluated the effect of preprocedural diuretics treatment on clinical outcomes. Patients were divided into 2 groups as follows: the Diuretics group, who received diuretic treatment before TAVI (n = 2,073), and the Non-Diuretics group without diuretic treatment (n = 2,830). The median observation period was 2.1 years. The Diuretics group was older and had higher surgical risk scores and more comorbidities, including prior myocardial infarction, atrial fibrillation/flutter, and peripheral artery disease. The Diuretics group included more patients with New York Heart Association (NYHA) classification III/IV, lower left ventricular ejection fraction, and reduced renal function. They had significantly worse all-cause and cardiovascular mortality than those in the Non-Diuretics group (38% versus 26% and 18% versus 10%, respectively; P < 0.001 by log-rank test). After propensity score matching to minimize the influence of confounding factors, preoperative diuretic treatment was associated with worse all-cause mortality (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.06-1.58, P = 0.012) and cardiovascular mortality (HR: 1.61, 95%CI: 1.15-2.26, P = 0.006). Two fifths of AS patients who undergoing TAVI received preoperative diuretics, and those patients had worse all-cause and cardiovascular mortality. Preprocedural diuretic treatment was an independent predictor of all-cause and cardiovascular mortality after TAVI.