Asymptomatic severe aortic stenosis: improved survival with early intervention

  • Gahl B & al.
  • JAMA Cardiol
  • 8 Jul 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In patients with asymptomatic severe aortic stenosis, early intervention is significantly associated with better survival, according to the results of this meta-analysis.

Why this matters

  • The decision point for early intervention in severe asymptomatic aortic stenosis has been unclear.
  • These authors analyzed the natural history of the disease and associations of early intervention with survival.

Key results

  • 29 studies included, N=4075; 11,901 years of follow-up.
  • Early intervention vs conservative treatment was linked to significantly reduced all-cause mortality: HR, 0.38 (95% CI, 0.25-0.58).
  • Rates per 100 patients per year (95% CIs):
    • All-cause death: 4.8 (3.6-6.4).
      • 21 studies; n=3041; median follow-up, 2.3 (interquartile range, 1.7-3.4) years.
    • Cardiac death: 3.0 (2.2-4.1).
      • 18 studies; n=2813; median follow-up, 2.1 (1.4-2.9) years.
    • Congestive heart failure death: 2.0 (1.3-3.1). 
      • 11 studies; n=1809; median follow-up, 2.3 (1.9-2.9) years.
    • Sudden death: 1.1 (0.6-2.1).
      • 12 studies; n=1767; median follow-up, 2.3 (1.7-3.1) years.
    • Indication for valve intervention: 18.1 (12.8-25.4).
      • 11 studies; n=1754; median follow-up, 2.3 (1.8-3.2) years.
  • Stenosis severity and left ventricular dysfunction were factors most associated with death or valve intervention on multivariable analysis.

Study design

  • Systematic review, meta-analysis of observational studies.
  • Funding: None disclosed.

Limitations

  • Many studies were single center, retrospective, all observational, risking confounding.