What is the clinical evidence from this study?

Study design: Observational. Population: Chinese patients with moderate-to-severe aortic stenosis, mean age 66 years, including patients eligible or not eligible for aortic valve replacement (n=544). Intervention: Aortic valve replacement (either surgical or transcatheter) vs. No aortic valve replacement. Primary outcome: All-cause mortality during follow-up (HR 6.891, 95% CI 3.083–15.401, p=<0.001).

March 2, 2026Open Access

Evaluation of EuroSCORE II to Determine the Prognosis of Patients With Moderate-To-Severe Aortic Stenosis: A Long-Term Retrospective Study

Q: What are the key findings of this study?

Aortic valve replacement reduced all-cause mortality from 55.4% to 13.4% in high-risk (EuroSCORE II ≥4%) Chinese patients with moderate-to-severe aortic stenosis, with a hazard ratio of 6.891 (95% CI 3.083–15.401; p < 0.001) favoring intervention.

Q: What does this research mean for the field?

Aortic valve replacement significantly reduces long-term all-cause mortality in high-risk (EuroSCORE II ≥4%) Chinese patients with moderate-to-severe aortic stenosis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This research assesses how well EuroSCORE II predicts long-term mortality in patients with moderate-to-severe aortic stenosis, focusing on the role of aortic valve replacement.

Key Result

Aortic valve replacement reduced all-cause mortality from 55.4% to 13.4% in high-risk (EuroSCORE II ≥4%) Chinese patients with moderate-to-severe aortic stenosis, with a hazard ratio of 6.891 (95% CI 3.083–15.401; p < 0.001) favoring intervention.

Key Points

This research assesses how well EuroSCORE II predicts long-term mortality in patients with moderate-to-severe aortic stenosis, focusing on the role of aortic valve replacement.
Analyzed 544 patients with moderate-to-severe aortic stenosis grouped by EuroSCORE II value and aortic valve replacement status.
Utilized Kaplan–Meier survival analysis and Cox regression to evaluate associations between EuroSCORE II and long-term mortality.
Performed receiver operating characteristic analysis to identify the optimal EuroSCORE II cut-off value for mortality prediction.
132 patients (24.3%) reached the endpoint during a median follow-up of 3.45 years.
Higher all-cause mortality rates were found in patients without AVR with EuroSCORE II ≥4% compared to other groups (55.4% vs. significantly lower rates).
Cox regression indicated a 6.89-fold increased mortality risk for patients without AVR and higher EuroSCORE II values (HR 6.891, p < 0.001).
The optimal cut-off value for predicting mortality in patients without AVR was identified as 2.23% (AUC 0.675).

Study Design

Type

Observational (n=544)

Multicenter

Yes

Structured PICO

Does EuroSCORE II and AVR status predict long-term all-cause mortality in Chinese patients with moderate-to-severe aortic stenosis?

Population

544 Chinese patients with moderate-to-severe aortic stenosis (AS), mean age 66.00 years, 55.15% male. Inclusion criteria: initial diagnosis of moderate-to-severe AS without severe dysfunction or malignancy of other organs; no prior AVR history. Exclusion criteria: missing baseline data.

Intervention

EuroSCORE II risk stratification (cut-off value of 4%) and aortic valve replacement (AVR) status

Outcome

All-cause mortality from the time of diagnosishard clinical

EuroSCORE II is a strong independent predictor of long-term all-cause mortality in patients with moderate-to-severe aortic stenosis, particularly in those who do not undergo aortic valve replacement.

Main Result

Effect estimate: HR 6.891 (95% CI 3.083–15.401)

Absolute Event Rate: 13.4% vs 55.4%

p-value: p=<0.001

Limitations

Retrospective observational design with inherent selection bias
Relatively limited sample size from Chinese centers limiting generalizability
Static measurement of echocardiographic and laboratory parameters risking measurement bias
Applicability of EuroSCORE II limited by lack of etiological differentiation of aortic stenosis
Modest accuracy of EuroSCORE II for mortality prediction demands supplementation with clinical and imaging data

Abstract

Background: Aortic stenosis (AS) is a prevalent heart valve disease; however, morbidity and mortality are significantly reduced by aortic valve replacement (AVR). The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used to assess perioperative mortality risk in patients with severe AS undergoing AVR. This study aimed to evaluate the prognostic value of EuroSCORE II for long-term all-cause mortality in Chinese patients with moderate-to-severe AS, determine whether AVR affects this prognostic value, and identify the best cut-off value for low-risk EuroSCORE II patients without AVR. Methods: A total of 544 patients with moderate-to-severe AS were divided into four groups based on the associated EuroSCORE II value (cut-off of 4%) and whether the patient had previously undergone AVR. Kaplan–Meier survival analysis, Cox regression, and subgroup analyses were performed to assess the association between EuroSCORE II and all-cause mortality. A receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for predicting mortality. Results: A total of 132 (24.3%) participants reached the endpoint during a median follow-up of 3.45 years. Patients with a EuroSCORE II ≥4% who did not undergo AVR had significantly higher all-cause mortality rates compared to other groups (55.4% vs. 6.5%, 32.7%, and 13.4%; p < 0.001). Kaplan–Meier analysis confirmed these findings (log-rank test, p < 0.001). Cox regression showed a 6.89-fold increased risk in patients without AVR and higher EuroSCORE II values (hazard ratio (HR), 6.891; 95% confidence interval (CI), 3.083–15.401; p < 0.001). The optimal cut-off value for predicting mortality in patients without AVR was 2.23% (area under the curve (AUC), 0.675). Conclusions: Both EuroSCORE II (cut-off value of 4%) and AVR status were independently associated with the long-term prognosis of patients with moderate-to-severe AS. Clinical Trial Registration: NCT06069232, https://clinicaltrials.gov/study/NCT06069232.

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