Why the study?
The impact of clinical presentation among patients with aortic stenosis undergoing aortic valve replacement needed to be described.
Does clinical presentation acuity (acute or progressive valve syndrome vs asymptomatic) impact mortality and heart failure hospitalization in patients undergoing aortic valve replacement for aortic stenosis?
Does clinical presentation acuity (acute or progressive valve syndrome vs asymptomatic) impact mortality and heart failure hospitalization in patients undergoing aortic valve replacement for aortic stenosis?
In patients undergoing aortic valve replacement for aortic stenosis, presenting with acute valve syndrome is common and associated with significantly higher risks of mortality and heart failure hospitalization at 2 years compared to asymptomatic presentation.
Acute valve syndrome presentation was associated with higher post-AVR mortality; leaves open whether earlier intervention improves outcomes in aortic stenosis.
Background: To describe the impact of clinical presentation among patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR). Methods: We analyzed a real-world dataset including patients from 29 US hospitals (egnite Database, egnite). Patients over 18 years old with moderate or greater AS undergoing AVR were included. Patients were classified into 3 groups according to the acuity and severity of clinical presentation prior to AVR: (i) asymptomatic, (ii) progressive signs and symptoms (progressive valve syndrome [PVS]), and (iii) acute or advanced signs and symptoms (acute valve syndrome [AVS]). Mortality and heart failure hospitalization after AVR were examined with Kaplan-Meier estimates, with results compared using the log-rank test. Results: Among 2,009,607 patients in our database, 17,838 underwent AVR (78.6% transcatheter AVR, 21.4% surgical AVR). Age was 76.5 ± 9.7 years, and 40.2% were female. Prior to AVR, 2504 (14.0%) were asymptomatic, 6116 (34.3%) presented with PVS, and 9218 (51.7%) presented with AVS. At 2 years, the estimated rate of mortality for asymptomatic, PVS, and AVS were 5.8% (4.6%-7.0%), 7.6% (6.7%-8.4%), and 17.5% (16.5%-18.5%), respectively, and the estimated rate of hospitalization with heart failure for asymptomatic, PVS, and AVS were 11.1% (9.5%-12.6%), 19.0% (17.8%-20.2%), and 41.5% (40.2%-42.8%), respectively. After adjustment, patients presenting with AVS had increased risk of mortality after AVR (hazard ratio, 2.2; 95% CI, 1.8-2.6). Conclusions: From a large, real-world database of patients undergoing AVR for AS, most patients presented with AVS, which was associated with an increased risk of mortality and heart failure hospitalization.
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Généreux et al. (2024) studied this question.
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