Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention
Por:
Martinez-Selles, M, Doblas, JJG, Hevia, AC, de la Villa, BG, Ferreira-Gonzalez, I, Tello, AA, Ogando, RA, Vera, TR, Jimenez, AA, Carrillo, P, Pascual, CR, Romeva, MCI, Borras, X, Cornide, L, Lopez-Palop, R
Publicada:
1 jun 2014
Resumen:
Objective. To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS).
Study Design. Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katzindex.
Setting. Transnational registry in Spain.
Subjects. We included 928 patients aged >= 80 years with severe symptomatic AS.
Interventions. Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy.
Main outcome measures. All-cause death.
Results. Mean age was 84.2 +/- 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 +/- 4.6 months and to TAVI 2.1 +/- 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002).
Conclusion. Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
Filiaciones:
Martinez-Selles, M:
Hosp Gen Univ Gregorio Maranon, Serv Cardiol, Madrid 28007, Spain
Univ Europea Madrid, Madrid, Spain
Doblas, JJG:
Hosp Clin Univ Virgen de la Victoria, Serv Cardiol, Malaga, Spain
Hevia, AC:
Hosp Univ Cent Asturias, Serv Cardiol, Oviedo, Spain
de la Villa, BG:
Hosp Manacor, Serv Cardiol, Mallorca, Spain
Ferreira-Gonzalez, I:
Hosp Valle De Hebron, CIBERESP, Unidad Epidemiol, Serv Cardiol, Barcelona, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
Tello, AA:
Hosp Univ Vall dHebron, Serv Cardiol, Barcelona, Spain
Ogando, RA:
Hosp Clin Univ, Serv Cardiol, Valladolid, Spain
Vera, TR:
Fdn Hosp Son Llatzer, Serv Cardiol, Palma De Mallorca, Spain
Jimenez, AA:
Hosp Clin Salamanca, Serv Cardiol, Salamanca, Spain
Carrillo, P:
Hosp Univ San Juan, Serv Cardiol, Alacant, Spain
Pascual, CR:
Complejo Hosp Univ Meixoeiro, Serv Geriatria, Vigo, Spain
Romeva, MCI:
Hosp Plato, Serv Cardiol, Barcelona, Spain
Borras, X:
Hosp Santa Creu & St Pablo, Serv Cardiol, Barcelona, Spain
Cornide, L:
Hosp Sureste, Med Interna Serv, Arganda Del Rey, Spain
Lopez-Palop, R:
Hosp Univ San Juan, Serv Cardiol, Alacant, Spain
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