The Mortality Burden of Untreated Aortic Stenosis

医学 内科学 狭窄 死亡率 心脏病学 多元分析 主动脉瓣狭窄 置信区间 审查(临床试验) 病理
作者
Philippe Généreux,Rahul Sharma,Robert J. Cubeddu,LaTayia Aaron,Omar Abdelfattah,Konstantinos Koulogiannis,Leo Marcoff,Mostafa Naguib,Samir Kapadia,Rajendra Makkar,Vinod H. Thourani,Benjamin S. van Boxtel,David J. Cohen,Michael Dobbles,Glenn R. Barnhart,Michelle Kwon,Philippe Pîbarot,Martin B. Leon,Linda D. Gillam
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:82 (22): 2101-2109 被引量:26
标识
DOI:10.1016/j.jacc.2023.09.796
摘要

The American College of Cardiology/American Heart Association guidelines recommend the assessment and grading of severity of aortic stenosis (AS) as mild, moderate, or severe, per echocardiogram, and recommend aortic valve replacement (AVR) when the AS is severe. The authors sought to describe mortality rates across the entire spectrum of untreated AS from a contemporary, large, real-world database. We analyzed a deidentified real-world data set including 1,669,536 echocardiographic reports (1,085,850 patients) from 24 U.S. hospitals (egnite Database, egnite). Patients >18 years of age were classified by diagnosed AS severity. Untreated mortality and treatment rates were examined with Kaplan-Meier (KM) estimates, with results compared using the log-rank test. Multivariate hazards analysis was performed to assess associations with all-cause mortality. Among 595,120 patients with available AS severity assessment, the KM-estimated 4-year unadjusted, untreated, all-cause mortality associated with AS diagnosis of none, mild, mild-to-moderate, moderate, moderate-to-severe, or severe was 13.5% (95% CI: 13.3%-13.7%), 25.0% (95% CI: 23.8%-26.1%), 29.7% (95% CI: 26.8%-32.5%), 33.5% (95% CI: 31.0%-35.8%), 45.7% (95% CI: 37.4%-52.8%), and 44.9% (95% CI: 39.9%-49.6%), respectively. Results were similar when adjusted for informative censoring caused by treatment. KM-estimated 4-year observed treatment rates were 0.2% (95% CI: 0.2%-0.2%), 1.0% (95% CI: 0.7%-1.3%), 4.2% (95% CI: 2.0%-6.3%), 11.4% (95% CI: 9.5%-13.3%), 36.7% (95% CI: 31.8%-41.2%), and 60.7% (95% CI: 58.0%-63.3%), respectively. After adjustment, all degrees of AS severity were associated with increased mortality. Patients with AS have high mortality risk across all levels of untreated AS severity. Aortic valve replacement rates remain low for patients with severe AS, suggesting that more research is needed to understand barriers to diagnosis and appropriate approach and timing for aortic valve replacement.
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