The Mortality Burden of Untreated Aortic Stenosis.

BACKGROUND

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.

OBJECTIVES

The authors sought to describe mortality rates across the entire spectrum of untreated AS from a contemporary, large, real-world database.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Généreux has served as a consultant for, an advisor for, and received speaker fees from Abbott Vascular, Abiomed, Edwards Lifesciences, and Medtronic; has served as a consultant for Boston Scientific, GE Healthcare, iRhythm Technologies, OpSens, Siemens, and Teleflex; has served as a consultant for and PI of the Eclipse Trial for Cardiovascular System Inc; has served as a proctor for, received research grants from, and served as PI for the EARLY-TAVR and PROGRESS trials for Edwards Lifesciences; has equity in and served as a consultant for Pi-Cardia, Puzzle Medical, Saranas, and Soundbite Medical Inc; has served as a consultant for and received speaker fees from Shockwave; has served as a consultant for and PI of the ALTA Valve Feasibility study for 4C Medical; and has served as a consultant and advisor for egnite, Inc. Dr Sharma has served as a consultant and advisor for Edwards Lifesciences, Boston Scientific, Abbott, Philips, Siemens, and egnite, Inc. Dr Cubeddu has served on the Speakers Bureau for Abbott Laboratories, Edwards Lifesciences, and Gore Medical. Dr Thourani has served on the advisory board for Edwards Lifesciences, Abbott Vascular, Atricure, Cryolife, JenaValve, Shockwave, and Boston Scientific. Dr Makkar has received grant support/research contracts from Edwards Lifesciences and St Jude Medical; and has received consultant fees/honoraria and served on the Speakers Bureaus of Abbott Vascular, Cordis Corporation, and Medtronic. Dr Cohen has received research grant support from Edwards Lifesciences, Boston Scientific, Abbott, Medtronic, Philips, Zoll Medical, iRhythm, and Corvia; and has served as a consultant for Edwards Lifesciences, Boston Scientific, Abbott, Medtronic, and Corvia. Mr Dobbles and Dr Kwon have equity, stock(s), and/or options in and are employees of egnite, Inc. Dr Barnhart has equity, stock(s), and/or options in and was employed at egnite, Inc at the time of the study. Dr Pibarot has received institutional funding from Edwards Lifesciences, Medtronic, Pi-Cardia, Cardiac Success, and Roche Diagnostics for echocardiography core laboratory analyses, blood biomarker analyses, and research studies in the field of interventional and pharmacologic treatment of valvular heart diseases, for which he received no personal compensation. Dr Leon has received institutional clinical research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Gillam has served as a consultant for Medtronic, Philips, Edwards Lifesciences, and egnite, Inc; and has core laboratory contracts (no direct compensation) with Edwards Lifesciences, Medtronic, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.