Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. (27th March 2014)

• Record Type: Journal Article
• Authors: 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.; Rodríguez Pascual, C.; Casares i Romeva, M.; Borras, X.; Cornide, L.; López‐Palop, R.; the PEGASO Registry Group
• Is Part Of: Journal of internal medicine. Volume 275:Number 6(2014:Jun.)
• Page Start: 608
• Page End: 620
• Publication Date: 2014-03-27
• Subjects: Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.12174
• Languages: English
• ISSNs: 0954-6820

Abstract

<abstract abstract-type="main" id="joim12174-abs-0001"> <title>Abstract</title> <sec id="joim12174-sec-0001" sec-type="section"> <title>Objective</title> <p>To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS).</p> </sec> <sec id="joim12174-sec-0002" sec-type="section"> <title>Study Design</title> <p>Prospective, observational, multicenter registry. Centralized follow‐up included survival status and, if possible, mode of death and Katz index.</p> </sec> <sec id="joim12174-sec-0003" sec-type="section"> <title>Setting</title> <p>Transnational registry in Spain.</p> </sec> <sec id="joim12174-sec-0004" sec-type="section"> <title>Subjects</title> <p>We included 928 patients aged ≥80 years with severe symptomatic AS.</p> </sec> <sec id="joim12174-sec-0005" sec-type="section"> <title>Interventions</title> <p>Aortic‐valve replacement (AVR), transcatheter aortic‐valve implantation (TAVI) or conservative therapy.</p> </sec> <sec id="joim12174-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>All‐cause death.</p> </sec> <sec id="joim12174-sec-0007" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> < 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; <italic>P</italic> = 0.016) and AVR HR 0.56 (95% CI 0.39–0.8; <italic>P</italic> = 0.002).</p> </sec> <sec id="joim12174-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.</p> </sec> </abstract>