Key result
Early AVR cuts unplanned CV hospitalizations and stroke vs. surveillance, but shows no mortality difference.
Why the study?
Does early aortic valve replacement reduce mortality, hospitalization, and stroke in patients with asymptomatic severe aortic stenosis compared to clinical surveillance?
Meta-Analysis
Does early aortic valve replacement reduce mortality, hospitalization, and stroke in patients with asymptomatic severe aortic stenosis compared to clinical surveillance?
Early aortic valve replacement in asymptomatic severe aortic stenosis reduces unplanned cardiovascular/HF hospitalizations and stroke compared to clinical surveillance, challenging current guideline recommendations for surveillance.
Answers are grounded in this paper and cite their sources.
Supports early AVR to reduce hospitalizations and stroke in asymptomatic severe AS; confirms pooled RCT evidence without mortality benefit.
BACKGROUND: Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction. OBJECTIVES: The aim of this study was to conduct a study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) compared with CS in patients with asymptomatic severe AS. METHODS: Studies were quantitatively assessed in a meta-analysis using random-effects modeling. Prespecified outcomes included all-cause and cardiovascular mortality, unplanned cardiovascular or heart failure (HF) hospitalization, and stroke. The meta-analysis is registered at the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY202490002). RESULTS: = 50%; P = 0.23) were observed with early AVR compared with CS, although there was a high degree of heterogeneity among studies. CONCLUSIONS: In this meta-analysis of 4 RCTs, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization and stroke and no differences in all-cause and cardiovascular mortality compared with CS.
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Généreux et al. (2024) conducted a meta-analysis in Asymptomatic severe aortic stenosis. Early aortic valve replacement (AVR) vs. Clinical surveillance (CS) was evaluated on All-cause and cardiovascular mortality, unplanned cardiovascular or heart failure hospitalization, and stroke. Early aortic valve replacement significantly reduced unplanned cardiovascular or heart failure hospitalization and stroke compared with clinical surveillance, with no difference in mortality.
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