Aortic valve replacement reduced all-cause mortality from 55.4% to 13.4% in high-risk (EuroSCORE II ≥4%) Chinese patients with moderate-to-severe aortic stenosis, with a hazard ratio of 6.891 (95% CI 3.083–15.401; p < 0.001) favoring intervention.
Observational (n=544)
Sí
Does EuroSCORE II and AVR status predict long-term all-cause mortality in Chinese patients with moderate-to-severe aortic stenosis?
EuroSCORE II is a strong independent predictor of long-term all-cause mortality in patients with moderate-to-severe aortic stenosis, particularly in those who do not undergo aortic valve replacement.
Estimación del efecto: HR 6.891 (95% CI 3.083–15.401)
Tasa de eventos absoluta: 13.4% vs 55.4%
valor p: p=<0.001
Background: Aortic stenosis (AS) is a prevalent heart valve disease; however, morbidity and mortality are significantly reduced by aortic valve replacement (AVR). The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used to assess perioperative mortality risk in patients with severe AS undergoing AVR. This study aimed to evaluate the prognostic value of EuroSCORE II for long-term all-cause mortality in Chinese patients with moderate-to-severe AS, determine whether AVR affects this prognostic value, and identify the best cut-off value for low-risk EuroSCORE II patients without AVR. Methods: A total of 544 patients with moderate-to-severe AS were divided into four groups based on the associated EuroSCORE II value (cut-off of 4%) and whether the patient had previously undergone AVR. Kaplan–Meier survival analysis, Cox regression, and subgroup analyses were performed to assess the association between EuroSCORE II and all-cause mortality. A receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for predicting mortality. Results: A total of 132 (24.3%) participants reached the endpoint during a median follow-up of 3.45 years. Patients with a EuroSCORE II ≥4% who did not undergo AVR had significantly higher all-cause mortality rates compared to other groups (55.4% vs. 6.5%, 32.7%, and 13.4%; p < 0.001). Kaplan–Meier analysis confirmed these findings (log-rank test, p < 0.001). Cox regression showed a 6.89-fold increased risk in patients without AVR and higher EuroSCORE II values (hazard ratio (HR), 6.891; 95% confidence interval (CI), 3.083–15.401; p < 0.001). The optimal cut-off value for predicting mortality in patients without AVR was 2.23% (area under the curve (AUC), 0.675). Conclusions: Both EuroSCORE II (cut-off value of 4%) and AVR status were independently associated with the long-term prognosis of patients with moderate-to-severe AS. Clinical Trial Registration: NCT06069232, https://clinicaltrials.gov/study/NCT06069232.
Cai et al. (Wed,) conducted a observational in Chinese patients with moderate-to-severe aortic stenosis, mean age 66 years, including patients eligible or not eligible for aortic valve replacement (n=544). Aortic valve replacement (either surgical or transcatheter) vs. No aortic valve replacement was evaluated on All-cause mortality during follow-up (HR 6.891, 95% CI 3.083–15.401, p=<0.001). Aortic valve replacement reduced all-cause mortality from 55.4% to 13.4% in high-risk (EuroSCORE II ≥4%) Chinese patients with moderate-to-severe aortic stenosis, with a hazard ratio of 6.891 (95% CI 3.083–15.401; p < 0.001) favoring intervention.