Early intervention for asymptomatic severe AS showed no significant difference in all-cause death (RR 0.52; 95% CI 0.23-1.19) but reduced stroke and unplanned hospitalizations.
Meta-Analysis (n=1,427)
Does early intervention reduce mortality and adverse clinical events compared with conservative management in patients with asymptomatic severe aortic stenosis?
Early intervention for asymptomatic severe aortic stenosis significantly reduces stroke and unplanned hospitalizations compared to conservative management, though it does not show a statistically significant reduction in mortality.
Relative Risk: 0.52 (95% CI 0.23–1.19)
The timely management of asymptomatic severe aortic stenosis (AS) presents an important clinical dilemma. This meta-analysis aims to investigate whether early intervention can lead to improved clinical outcomes compared with conservative management in asymptomatic severe AS. We conducted a literature search of major databases to identify randomized controlled trials that compared an early intervention (either early surgical aortic valve replacement or early transcatheter aortic valve replacement) with conservative management in patients with asymptomatic severe AS. Data for clinical outcomes were extracted, and risk ratios (RRs) were calculated for all end points with corresponding 95% confidence intervals (CIs). The meta-analysis included 4 randomized controlled trials with 1427 patients. Compared with conservative management, early intervention was associated with no significant difference in all-cause RR, 0.52 (95% CI, 0.23-1.19) or cardiovascular death RR, 0.41 (95% CI, 0.10-1.64). A statistically significant reduction was observed in the risk of stroke RR, 0.60 (95% CI, 0.38-0.94) and unplanned hospitalizations RR, 0.49 (95% CI, 0.40-0.60) with an early intervention. The risk of myocardial infarction remained comparable RR, 0.67 (95% CI, 0.13-3.54). Early intervention can be a suitable treatment option for patients with asymptomatic severe AS who prefer proactive management of their condition.
Ahmed et al. (Wed,) conducted a meta-analysis in asymptomatic severe aortic stenosis (n=1,427). Early intervention (early surgical or transcatheter aortic valve replacement) vs. Conservative management was evaluated on all-cause death (RR 0.52, 95% CI 0.23-1.19). Early intervention for asymptomatic severe AS showed no significant difference in all-cause death (RR 0.52; 95% CI 0.23-1.19) but reduced stroke and unplanned hospitalizations.