Key result
Early aortic valve intervention cuts all-cause mortality ~55% vs. conservative management in asymptomatic severe AS.
Why the study?
Recent randomized trials supported earlier intervention in asymptomatic severe aortic stenosis, warranting a systematic review and meta-analysis to evaluate all available data comparing management strategies.
Does early aortic valve intervention reduce all-cause mortality in patients with asymptomatic severe aortic stenosis?
Meta-Analysis (n=302)
Does early aortic valve intervention reduce all-cause mortality in patients with asymptomatic severe aortic stenosis?
This meta-analysis provides strong evidence that early aortic valve intervention significantly reduces all-cause mortality and heart failure hospitalizations in patients with asymptomatic severe aortic stenosis.
Answers are grounded in this paper and cite their sources.
Supports early aortic valve intervention in asymptomatic severe AS; confirms mortality benefit from two recent RCTs.
Objectives The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies. Methods PubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were ‘asymptomatic’, ‘severe aortic stenosis’ and ‘intervention’. Results Meta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I 2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I 2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I 2 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I 2 77%). Conclusion This meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention. PROSPERO registration number CRD42022301037.
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Tsampasian et al. (2022) conducted a meta-analysis in Asymptomatic severe aortic stenosis (n=302). Early aortic valve intervention vs. Conservative management (watchful waiting) was evaluated on All-cause mortality (HR 0.45, 95% CI 0.24 to 0.86). Early aortic valve intervention reduced all-cause mortality by 55% compared to conservative management in patients with asymptomatic severe aortic stenosis.
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