Key result
TAVI or AVR linked to ~32% lower mortality vs conservative therapy in octogenarians with severe AS.
Why the study?
Factors influencing therapy choice and prognosis in octogenarians with severe symptomatic aortic stenosis were not well characterized.
Does aortic-valve replacement or transcatheter aortic-valve implantation reduce all-cause death compared to conservative therapy in octogenarians with severe symptomatic aortic stenosis?
Observational (n=928)
Yes
Does aortic-valve replacement or transcatheter aortic-valve implantation reduce all-cause death compared to conservative therapy in octogenarians with severe symptomatic aortic stenosis?
Hazard Ratio: 0.68 (95% CI 0.49–0.93)
p-value: p=0.016
In octogenarians with severe symptomatic aortic stenosis, planned intervention (TAVI or AVR) is associated with significantly lower mortality compared to conservative management.
Intervention may improve survival in symptomatic octogenarian severe AS; leaves open optimal selection amid observational bias.
OBJECTIVE: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING: Transnational registry in Spain. SUBJECTS: We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES: All-cause death. RESULTS: Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
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Martínez‐Sellés et al. (2013) conducted an observational in severe symptomatic aortic stenosis (n=928). TAVI or AVR vs. Conservative therapy was evaluated on All-cause death (HR 0.68, 95% CI 0.49-0.93, p=0.016). Planned intervention with TAVI (HR 0.68; 95% CI 0.49-0.93) or AVR (HR 0.56; 95% CI 0.39-0.80) was associated with lower mortality compared to conservative treatment in octogenarians with severe AS.