Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention
M Martínez-Sellés, J J Gómez Doblas, A Carro Hevia, B García de la Villa, I Ferreira-González, A Alonso Tello, R Andión Ogando, T Ripoll Vera, A Arribas Jiménez, P Carrillo, C Rodríguez Pascual, M Casares i Romeva, X Borras, L Cornide, R López-Palop, PEGASO Registry Group, Manuel Martínez-Sellés, Elisabet María Sánchez García, María Teresa Vidán Astiz, Pedro Luis Sánchez Fernández, Miriam Juárez Fernández, Iago Sousa Casasnovas, Ana María Pello Lázaro, Sandra Vázquez, Maria José Lorenzo, Lucía Fernández, Camino Bañuelos, Lorena Montes, María del Pilar Bao Alonso, Luís Cornide, Ángel Candela, David Dobarro, Juan José Gómez Doblas, Gonzalo Barón Esquivias, Guzmán Arquero García, Carmen Rus Mansilla, Carlos Pérez Muñoz, José María Cubero, Amelia Carro Hevia, Víctor Manuel Rodríguez Blanco, Bernardo García de la Villa, Tomás Ripoll Vera, Andrés Grau Sepúlveda, Albert Alonso, Ignacio Ferreira-González, María Casares i Romeva, Xavier Borrás, Carmen Amorós Galitó, Dolors Viles Bertran, Gabriel Vázquez, Ramón Andión Ogando, Antonio Arribas Jiménez, Ramón López-Palop, Pilar Carrillo, Albert Cordero Fort, Alejandro Jordan Torrent, Margarita Gudin Uriel, Jaime Agüero Ramón, Fernando de la Guía Galipien, Carlos Rodríguez Pascual, Francisco Calvo Iglesias, Virginia González Toda, Francisco Roncales, Asunción Araguas Biescas, Antonio Melero Pita, Esther Cambronero Cortinas, Miriam Victoria Sánchez Testal, Javier Enjuto Olabera, Javier Castellote, M Martínez-Sellés, J J Gómez Doblas, A Carro Hevia, B García de la Villa, I Ferreira-González, A Alonso Tello, R Andión Ogando, T Ripoll Vera, A Arribas Jiménez, P Carrillo, C Rodríguez Pascual, M Casares i Romeva, X Borras, L Cornide, R López-Palop, PEGASO Registry Group, Manuel Martínez-Sellés, Elisabet María Sánchez García, María Teresa Vidán Astiz, Pedro Luis Sánchez Fernández, Miriam Juárez Fernández, Iago Sousa Casasnovas, Ana María Pello Lázaro, Sandra Vázquez, Maria José Lorenzo, Lucía Fernández, Camino Bañuelos, Lorena Montes, María del Pilar Bao Alonso, Luís Cornide, Ángel Candela, David Dobarro, Juan José Gómez Doblas, Gonzalo Barón Esquivias, Guzmán Arquero García, Carmen Rus Mansilla, Carlos Pérez Muñoz, José María Cubero, Amelia Carro Hevia, Víctor Manuel Rodríguez Blanco, Bernardo García de la Villa, Tomás Ripoll Vera, Andrés Grau Sepúlveda, Albert Alonso, Ignacio Ferreira-González, María Casares i Romeva, Xavier Borrás, Carmen Amorós Galitó, Dolors Viles Bertran, Gabriel Vázquez, Ramón Andión Ogando, Antonio Arribas Jiménez, Ramón López-Palop, Pilar Carrillo, Albert Cordero Fort, Alejandro Jordan Torrent, Margarita Gudin Uriel, Jaime Agüero Ramón, Fernando de la Guía Galipien, Carlos Rodríguez Pascual, Francisco Calvo Iglesias, Virginia González Toda, Francisco Roncales, Asunción Araguas Biescas, Antonio Melero Pita, Esther Cambronero Cortinas, Miriam Victoria Sánchez Testal, Javier Enjuto Olabera, Javier Castellote
Abstract
Objective: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS).
Study design: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index.
Setting: Transnational registry in Spain.
Subjects: We included 928 patients aged ≥80 years with severe symptomatic AS.
Interventions: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy.
Main outcome measures: All-cause death.
Results: 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, P < 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; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002).
Conclusion: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
Keywords: ageing; aortic stenosis; aortic surgery.
© 2013 The Association for the Publication of the Journal of Internal Medicine.
Source: PubMed