Early intervention reduced mortality by 48% (aHR 0.52) in moderate AS patients with high-stage extra-valvular damage, but had no significant benefit in low-stage patients.
Does early intervention improve survival compared to a watchful waiting strategy in patients with moderate aortic stenosis stratified by extra-valvular cardiac damage?
Early intervention for moderate aortic stenosis is associated with improved survival in patients with advanced extra-valvular cardiac damage, but not in those with early-stage damage.
Absolute Event Rate: 0% vs 0%
Abstract Background There is an increasing interest in pinpointing which patients with moderate aortic stenosis (AS) might benefit from early intervention. Purpose We aimed to compare the impact of early intervention with a watchful waiting strategy in patients with moderate AS according to the extent of extra-valvular cardiac damage. Methods In this multicentre retrospective cohort study, we included patients with moderate AS (aortic valve area between 1.0~1.5cm2) diagnosed between 2008 to 2020. Patients were categorized according to extra-valvular cardiac damage: stage 0 (no damage), stage 1 (damage in left ventricle), stage 2 (damage in left atrial or mitral valve), stage 3 (damage in pulmonary vasculatures or tricuspid valve), and stage 4 (damage in right ventricle). Low-stage group included patients in stage 0–2, whereas high-stage group included those with stage 3 and 4. The primary outcome was all-cause death. Early intervention vs. watchful waiting strategy was compared in the entire and propensity score-matched cohorts. In this study, early intervention was defined as that conducted within one year of diagnosis. Results We included 2,474 patients with moderate AS. With a median follow-up of 3.6 years (interquartile range 1.4–6.3), 863 deaths occured. Patients in the high-stage group were associated with a significantly higher mortality than those in the low-stage group in multivariable Cox-regression analysis (adjusted hazard ratio aHR 1.48, 95% confidence interval CI 1.26–1.73, p0.001). Among patients with high-stage moderate AS, those who underwent early intervention were associated with improved survival when compared to those in the watchful waiting group (aHR 0.52, 95% CI 0.31-0.87). However, we found no significant difference between two groups among the low-stage patients (aHR 0.93, 95% CI 0.67-1.31). Consistent results were demonstrated in the propensity score-matched cohort. Conclusion(s) Classification according to extra-valvular cardiac damage in moderate AS might help differentiate prognoses. High-stage moderate AS was associated with poor prognosis, and early intervention might benefit these patients. However, the impact of early intervention was minimal in those with low-stage who had relatively benign prognoses.
Lim et al. (Sat,) reported a other. Early intervention reduced mortality by 48% (aHR 0.52) in moderate AS patients with high-stage extra-valvular damage, but had no significant benefit in low-stage patients.