What is the clinical evidence from this study?

Study design: Cohort. Population: Mild to moderate aortic stenosis (n=787). Intervention: Mild to moderate aortic stenosis vs. General population. Primary outcome: Cardiac death (HR 17.16, 95% CI 13.65-21.59, p=<0.001).

What does this research mean for the field?

Patients with mild to moderate aortic stenosis have a significantly higher risk of cardiac death compared to the general population, and the presence of established coronary artery disease further increases this risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2021Journal of Korean Medical ScienceOpen Access

Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease

Q: What are the key findings of this study?

Patients with mild to moderate aortic stenosis had a significantly higher risk of cardiac death compared to the general population (HR 17.16), and the presence of established coronary artery disease further increased this risk.

Q: What does this research mean for the field?

Patients with mild to moderate aortic stenosis have a significantly higher risk of cardiac death compared to the general population, and the presence of established coronary artery disease further increases this risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Patients with mild to moderate aortic stenosis had a significantly higher risk of cardiac death compared to the general population (HR 17.16), and the presence of established coronary artery disease further increased this risk.

Why the study?

There is an incomplete understanding of the natural course of mild to moderate aortic stenosis and its association with CAD.

Does the presence of coronary artery disease or the use of statins affect the long-term risk of cardiac death and aortic valve replacement in patients with mild to moderate aortic stenosis?

Study Design

Type

Cohort (n=787)

Multicenter

Structured PICO

Does the presence of coronary artery disease or the use of statins affect the long-term risk of cardiac death and aortic valve replacement in patients with mild to moderate aortic stenosis?

Population

787 asymptomatic patients with mild to moderate aortic stenosis (peak aortic valve velocity 2.0–3.9 m/sec, aortic valve area > 1.0 cm2, and mean pressure gradient < 40 mmHg, EF ≥ 50%), mean age 71.0, 59.7% male, based in Korea. Excluded patients with severe mitral disease, prosthetic valve in situ, infective endocarditis, heart failure, or death within 30 days of index echocardiography.

Intervention

Presence of established coronary artery disease (CAD) (n=176) or use of statin therapy (n=407).

Comparator

Absence of established CAD (n=611) or non-use of statins (n=380). Additionally, the overall cohort was compared to an age- and sex-matched general population cohort (n=39,350).

Outcome

Co-primary outcomes of cardiac death and aortic valve replacement (AVR) for AS, as well as the composite outcome of cardiac death and AVR, assessed over a median follow-up of 92 months.hard clinical

Main Result

Effect estimate: HR 17.16 (95% CI 13.65-21.59)

p-value: p=<0.001

Mild to moderate aortic stenosis carries a significantly higher long-term mortality risk compared to the general population, a risk that is exacerbated by concurrent coronary artery disease but potentially mitigated by statin therapy.

Limitations

Retrospective nature cannot exclude selection biases
Excluded patients who died within 30 days of index echocardiography
Tertiary referral center may have higher cardiac death rates than average
Lack of follow-up echocardiography data to evaluate AS progression
Only had prescription data at the time of index echocardiography without exact duration of statin use
Retrospective nature with potential selection biases
Tertiary referral center population may have higher baseline risk than general population
Lack of follow-up echocardiography data to evaluate progression of AS
Lack of data on the exact duration of statin use

Implication

Patients with mild-moderate AS plus CAD warrant closer surveillance; leaves open whether statins modify cardiac death risk.

Abstract

BACKGROUND: There is an incomplete understanding of the natural course of mild to moderate aortic stenosis (AS). We aimed to evaluate the natural course of patients with mild to moderate AS and its association with coronary artery disease (CAD). METHODS: We retrospectively analyzed 787 patients diagnosed with mild to moderate AS using echocardiography between 2004 and 2010. Cardiac death and aortic valve replacement (AVR) for AS were assessed. RESULTS: = 0.177). CONCLUSION: Mild to moderate AS does not have a benign course. The presence of CAD and statin use may affect the long-term prognosis of patients with mild to moderate AS.

Discussion

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Published by Journal of Korean Medical Science · CC BY-NC

Cite This Study

Lee et al. (2021) conducted a cohort in Mild to moderate aortic stenosis (n=787). Mild to moderate aortic stenosis vs. General population was evaluated on Cardiac death (HR 17.16, 95% CI 13.65-21.59, p=<0.001). Patients with mild to moderate aortic stenosis had a significantly higher risk of cardiac death compared to the general population (HR 17.16), and the presence of established coronary artery disease further increased this risk.

synapsesocial.com/papers/6a1caa565a7763abe7899508 https://doi.org/10.3346/jkms.2021.36.e47

Topics

Coronary artery disease

Statin therapy

Echocardiography

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Implication

Patients with mild-moderate AS plus CAD warrant closer surveillance; leaves open whether statins modify cardiac death risk.

Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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