Prognosis of Patients With Severe Aortic Stenosis After the Decision to Perform an Intervention |
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Authors: | Hugo González Saldivar Lourdes Vicent Alaminos Carlos Rodríguez-Pascual Gonzalo de la Morena Covadonga Fernández-Golfín Carmen Amorós Mario Baquero Alonso Luis Martínez Dolz Albert Ariza Solé Gabriela Guzmán-Martínez Juan José Gómez-Doblas Antonio Arribas Jiménez María Eugenia Fuentes Laura Galian Gay Martín Ruiz Ortiz Pablo Avanzas Emad Abu-Assi Tomás Ripoll-Vera Manuel Martínez-Sellés |
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Institution: | 1. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain;2. Servicio de Geriatría, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain;3. Unidad de Imagen, Servicio de Cardiología, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain;4. Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain;5. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;6. Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain;7. Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain;8. Servicio de Cardiología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain;9. Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdIPaz), Madrid, Spain;10. Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain;11. Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain;12. Servicio de Cardiología, Hospital Infanta Cristina, Badajoz, Spain;13. Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Barcelona, Spain;14. Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain;15. Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain;p. Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain;q. Servicio de Cardiología, Hospital Son Llàtzer, Instituto de Investigación Sanitaria de Palma (Idispa), Palma de Mallorca, Balearic Islands, Spain;r. Servicio de Cardiología, Hospital de Pontevedra, Vigo, Pontevedra, Spain;s. Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain;t. Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;u. Universidad Europea, Universidad Complutense, Madrid, Spain |
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Abstract: | Introduction and objectivesCurrent therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months.MethodsSubanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Diagnosis) registry in patients indicated for TAVI or SAVR.ResultsOf 726 patients with severe AS diagnosed in January 2014, the decision to perform an intervention was made in 300, who were included in the present study. The mean age was 74.0 ± 9.7 years. A total of 258 (86.0%) underwent an intervention: 59 TAVI and 199 SAVR. At the end of the year, 42 patients (14.0%) with an indication for an intervention did not receive it, either because they remained on the waiting list (34 patients) or died while waiting for the procedure (8 patients). Of the patients who died while on the waiting list, half did so in the first 100 days. The mean waiting time was 2.9 ± 1.6 for TAVI and 3.5 ± 0.2 months for SAVR (P = .03). The independent predictors of mortality were male sex (HR, 2.6; 95%CI, 1.1-6.0), moderate-severe mitral regurgitation (HR, 2.6; 95%CI, 1.5-4.5), reduced mobility (HR, 4.6; 95%CI, 1.7-12.6), and nonintervention (HR, 2.3; 95%CI, 1.02-5.03).ConclusionsPatients with severe aortic stenosis awaiting therapeutic procedures have a high mortality risk. Some clinical indicators predict a worse prognosis and suggest the need for early intervention. |
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Keywords: | Aortic stenosis Transcatheter aortic valve implantation Surgical valve replacement Waiting list Estenosis aórtica Implante percutáneo de válvula aórtica Cirugía de sustitución valvular Lista de espera AS aortic stenosis SAVR surgical aortic valve replacement TAVI transcatheter aortic valve implantation |
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