Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention

Martínez-Sellés, M., Gómez Doblas, J. J., Carro Hevia, A. , García de la Villa, B., Ferreira-González, I., Alonso Tello, A., Andión Ogando, R., Ripoll Vera, T., Arribas Jiménez, A., Carrillo, P., Rodriguez Pascual, C., Casares i Romeva, M., Borras, X., Cornide, L. and López-Palop, R. (2014) Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. Journal of Internal Medicine, 275 (6). pp. 608-620. ISSN 0954-6820

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Abstract

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 Katz index.

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.

Additional Information:This study was presented, in part, as an oral communication at the Congress of the European Society of Cardiology, Munich, Germany, September 2012. *The investigators, institutions and organizations participating in the PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario – Prognosis of symptomatic severe aortic stenosis in octogenarians) registry are listed in Appendix S1.
Keywords:Ageing, aortic stenosis, aortic surgery, NotOAChecked
Subjects:A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Science > School of Pharmacy
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ID Code:27797
Deposited On:05 Jul 2017 08:38

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