Early intervention in asymptomatic severe aortic stenosis reduced all-cause mortality by 55% compared with conservative management (HR 0.45; 95% CI 0.24 to 0.86).
Meta-Analysis (n=302)
Does early intervention reduce all-cause mortality in patients with asymptomatic severe aortic stenosis?
Early intervention in asymptomatic severe aortic stenosis significantly reduces all-cause mortality and heart failure hospitalizations compared to conservative management.
Hazard Ratio: 0.45 (95% CI 0.24–0.86)
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.
Tsampasian et al. (Sun,) conducted a meta-analysis in Asymptomatic severe aortic stenosis (n=302). Early intervention vs. Conservative management was evaluated on All-cause mortality (HR 0.45, 95% CI 0.24 to 0.86). Early intervention in asymptomatic severe aortic stenosis reduced all-cause mortality by 55% compared with conservative management (HR 0.45; 95% CI 0.24 to 0.86).
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