A Risk Prediction Model in Asymptomatic Patients with Severe Aortic Stenosis: CURRENT-AS risk score (original) (raw)
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Risk Score for Predicting Outcome in Patients With Asymptomatic Aortic Stenosis
2010
Background—The management of patients with asymptomatic severe aortic stenosis remains controversial. We sought to develop a continuous risk score for predicting the midterm development of symptoms or adverse events in this setting. Methods and Results—We prospectively followed 107 patients with asymptomatic aortic stenosis (aged 72 years (63 to 77); 35 women; aortic-jet velocity, 4.1 m/s (3.5 to 4.4)) at a
Risk stratification in asymptomatic severe aortic stenosis: a critical appraisal
European Heart Journal, 2012
Aortic stenosis is one of the most common forms of acquired valvular heart disease. The development of symptoms, namely syncope, angina, or heart failure, in patients with severe aortic stenosis predicts a high likelihood of mortality. Aortic valve replacement is the current standard of care. In truly asymptomatic patients, the risk of sudden death is perceived to be low; therefore many advocate conservative management of these patients until symptoms develop. Emerging data suggest that certain markers may identify subsets of asymptomatic patients who are at a high risk of cardiac events. This review critically appraises the growing plethora of adverse prognostic markers that have been identified and evaluates how these parameters may influence clinical practice and potentially identify patients in whom early surgical intervention is warranted.
Journal of the American Heart Association
Background-Data are scarce on the role of aortic valve area (AVA) to identify those patients with asymptomatic severe aortic stenosis (AS) who are at high risk of adverse events. We sought to explore the prognostic impact of AVA in asymptomatic patients with severe AS in a large observational database. Methods and Results-Among 3815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the present study included 1309 conservatively managed asymptomatic patients with left ventricular ejection fraction ≥50%. The study patients were subdivided into 3 groups based on AVA (group 1: AVA >0.80 cm 2 , N=645; group 2: 0.8 cm 2 ≥AVA >0.6 cm 2 , N=465; and group 3: AVA ≤0.6 cm 2 , N=199). The prevalence of very severe AS patients (peak aortic jet velocity ≥5 m/s or mean aortic pressure gradient ≥60 mm Hg) was 2.0%, 5.8%, and 26.1% in groups 1, 2, and 3, respectively. The cumulative 5-year incidence of AVR was not different across the 3 groups (39.7%, 43.7%, and 39.9%; P=0.43). The cumulative 5-year incidence of the primary outcome measure (a composite of aortic valve-related death or heart failure hospitalization) was incrementally higher with decreasing AVA (24.1%, 29.1%, and 48.1%; P<0.001). After adjusting for confounders, the excess risk of group 3 and group 2 relative to group 1 for the primary outcome measure remained significant (hazard ratio, 2.21, 95% CI, 1.56-3.11, P<0.001; and hazard ratio, 1.34, 95% CI, 1.01-1.78, P=0.04, respectively). Conclusions-AVA ≤0.6 cm 2 would be a useful marker to identify those high-risk patients with asymptomatic severe AS, who might benefit from early AVR.
How to Use Risk Score Systems on Severe Aortic Stenosis
Journal of Cardiology & Cardiovascular Therapy, 2017
The mostused score isthe STS score. This was generated from the U.S. database separated into three large cohorts with more than 100,000 patients each. In groups 2 and 3, only valve surgeries (aortic valve replacement, mitral valve replacement and mitral valve repair), combined valve surgery and coronary artery bypass grafting (CABG) were respectively included. The performance of the STS model are poor at predicting 30-day mortality post TAVR [4]
Outcomes in asymptomatic, severe aortic stenosis
PLOS ONE, 2021
Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic pat...
Circulation: Cardiovascular Quality and Outcomes, 2009
Background— Some patients with severe symptomatic aortic stenosis (AS) do not undergo aortic valve replacement (AVR) despite demonstrated symptomatic and survival advantages and despite unequivocal guideline recommendations for surgical evaluation. Methods and Results— In 3 large tertiary care institutions (university, Veterans Affairs, and private practice) in Washtenaw County, Mich, patients were identified with unrefuted echocardiography/Doppler evidence of severe AS during calendar year 2005. Medical records were retrospectively reviewed for symptoms, referral for AVR, calculated operative risk for AVR, and rationale as to why patients did not undergo valve replacement. Of 369 patients with severe AS, 191 (52%) did not undergo AVR. Of these, 126 (66%, 34% of total) had symptoms consistent with AS. The most common reasons cited for absent intervention were comorbidities with high operative risk (61 patients [48%]), patent refusal (24 patients [19%]), and symptoms unrelated to AS ...
Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis
Heart, 2011
Objective The management of asymptomatic severe and very severe aortic stenosis (AS) remains unestablished. This study aimed to investigate the clinical outcomes of severe versus very severe AS patients. Design A single centre, retrospective cohort study. Patients and Methods The study retrospectively reviewed 108 conservatively treated patients with severe AS (a maximal jet velocity 4.0m/s,ormeanaorticpressuregradient(MPG)4.0 m/s, or mean aortic pressure gradient (MPG) 4.0m/s,ormeanaorticpressuregradient(MPG)40 mm Hg, or an aortic valve area (AVA) <1.0 cm 2) and 58 patients with very severe AS (a maximal jet velocity 5.0m/s,orMPG5.0 m/s, or MPG 5.0m/s,orMPG50 mm Hg or an AVA <0.6 cm 2). Clinical outcomes were compared between the two groups, considering the existence of symptoms. Main Outcome Measures All-cause mortality and valve-related event, defined by a composite of cardiac death and hospitalisation because of heart failure. Results Mean follow-up was 5.563.1 years. Fifty-six patients (52%) with severe AS and 20 patients (34%) with very severe AS were asymptomatic. Very severe AS had poorer survival and valve-related event-free survival than severe AS at 3 years (77% vs 88%, p<0.01; 75% vs 88%, p<0.001, respectively). In addition, the 3-year survival and valve-related event-free survival of asymptomatic very severe AS were comparable with symptomatic severe AS, but they were significantly worse than asymptomatic severe AS (p<0.01 and p<0.001, respectively). Conclusions Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes.