Key result
Symptoms in severe AS are linked to ~64% higher risk of valve death or HF hospitalization.
Why the study?
The differences in long-term clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis were unknown.
Do symptomatic patients with severe aortic stenosis have worse clinical outcomes compared to asymptomatic patients?
Cohort (n=3,023)
Yes
Do symptomatic patients with severe aortic stenosis have worse clinical outcomes compared to asymptomatic patients?
Hazard Ratio: 1.64 (95% CI 1.41–1.96)
Absolute Event Rate: 32.3% vs 27.6%
p-value: p=<0.001
Symptomatic patients with severe aortic stenosis face a significantly higher risk of aortic valve-related death or heart failure hospitalization compared to asymptomatic patients, underscoring the critical need for timely aortic valve replacement.
Symptomatic severe AS patients face excess adjusted risk for valve-related events; leaves open whether symptoms alone should guide earlier AVR timing.
It is unknown how much different are the clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis (AS). In the CURRENT AS registry enrolling 3,815 consecutive patients with severe AS, we compared the long-term outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea: N = 813, syncope: N = 136, and angina: N = 266) without heart failure (HF) hospitalization. Symptomatic patients had greater AS severity, and more depressed left ventricular function than asymptomatic patients without much difference in other baseline characteristics. During a median follow-up of 3.2 years, aortic valve replacement (AVR) was performed in 62% of symptomatic patients, and 38% of asymptomatic patients. The cumulative 5-year incidences for the primary outcome measure (a composite of aortic valve-related death or HF hospitalization) was higher in symptomatic patients than in asymptomatic patients (32.3% versus 27.6%, P < 0.001). After adjusting for AVR and other variables, the greater risk of symptomatic relative to asymptomatic patients for the primary outcome measure was significant (hazard ratio 1.64, 95% confidence interval 1.41-1.96, P < 0.001). In conclusions, the excess risk of symptomatic relative to asymptomatic patients with severe AS for the aortic valve-related event was significant. However, the prevalence of AVR in symptomatic patients was not optimal.
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Kanamori et al. (2018) conducted a cohort in Severe aortic stenosis (n=3,023). Presence of symptoms (exertional dyspnea, syncope, or angina) vs. Asymptomatic was evaluated on Composite of aortic valve-related death or heart failure hospitalization (HR 1.64, 95% CI 1.41-1.96, p=<0.001). The presence of symptoms in patients with severe aortic stenosis was associated with a significantly higher risk of aortic valve-related death or heart failure hospitalization compared to asymptomatic patients (HR 1.64).
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