Key result
Early AVR cuts all-cause mortality ~59% vs watchful waiting in asymptomatic severe AS.
Why the study?
The optimal timing of intervention for asymptomatic patients with severe aortic stenosis remains controversial.
Does early aortic valve replacement reduce mortality compared to watchful waiting in asymptomatic patients with severe aortic stenosis?
Meta-Analysis (n=4,679)
Does early aortic valve replacement reduce mortality compared to watchful waiting in asymptomatic patients with severe aortic stenosis?
Odds Ratio: 0.41 (95% CI 0.34–0.5)
p-value: p=<0.01
Early aortic valve replacement significantly reduces all-cause and cardiovascular mortality, as well as heart failure hospitalizations, compared to watchful waiting in asymptomatic patients with severe aortic stenosis.
Supports early aortic valve replacement over watchful waiting in asymptomatic severe aortic stenosis; confirms mortality benefit in Level 1 meta-analysis.
Background Aortic stenosis (AS) is the most common valvular disease in developed countries. However, the specific timing of intervention for asymptomatic patients with severe AS remains controversial. Purpose To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic patients with AS. Methods We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for both interventional or observational studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed. Results Thirteen studies were included in which two were randomised clinical trials. A total of 4,679 patients were included, providing a 1,268 pooled death events (327 in early AVR and 941 in WW). Our meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group, although with a moderate amount of heterogeneity between studies in the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence interval [CI] 0.34, 0.50, P<0.01; I2=60%). An early surgery strategy displayed a significantly lower cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01, I2=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I2=0%) and myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14, I2=0%). Conclusions Our pooled data suggest that an early-AVR strategy is preferable for asymptomatic patients with severe AS. Funding Acknowledgement Type of funding sources: None.
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Costa et al. (2022) conducted a meta-analysis in Asymptomatic severe aortic stenosis (n=4,679). Early aortic valve replacement (AVR) vs. Watchful waiting (WW) was evaluated on All-cause mortality (OR 0.41, 95% CI 0.34-0.50, p=<0.01). Early aortic valve replacement significantly reduced all-cause mortality compared with watchful waiting in asymptomatic severe aortic stenosis (OR 0.41; 95% CI 0.34-0.50; P<0.01).
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