Comparison of 1-Year Outcome in Patients With Severe Aorta Stenosis Treated Conservatively or by Aortic Valve Replacement or by Percutaneous Transcatheter Aortic Valve Implantation (Data from a Multicenter Spanish Registry)

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• 作者：Hugo Gonzá ; lez-Saldivar ; MD^a ; Carlos Rodriguez-Pascual ; MD ; PhD^b ; Gonzalo de la Morena ; MD^c ; Covadonga Ferná ; ndez-Golfí ; n ; MD ; PhD^d ; Carmen Amoró ; s ; MD^e ; Mario Baquero Alonso ; MD^f ; Luis Martí ; nez Dolz ; MD^g ; Albert Ariza Solé ; MD ; PhD^h ; Gabriela Guzmá ; n-Martí ; nez ; MDⁱ ; Juan José ; Gó ; mez-Doblas ; MD ; PhD^j ; Antonio Arribas Jimé ; nez ; MD^k ; Marí ; a Eugenia Fuentes ; MD^l ; Laura Galian Gay ; MD^m ; Martin Ruiz Ortiz ; MD ; PhDⁿ ; Pablo Avanzas ; MD ; PhD^o ; Emad Abu-Assi ; MD^p ; Tomá ; s Ripoll-Vera ; MD^q ; Oscar Dí ; az-Castro ; MD ; PhD^r ; Eduardo P. Osinalde ; MD ; PhD^s ; Manuel Martí ; nez-Sellé ; s ; MD ; PhD^t ; ^{mmselles@secardiologia.es" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the Influencia del Diagnó ; stico de Estenosis Aó ; rtica Severa&mdash ; Influence of the Severe Aortic Stenosis Diagnosis (IDEAS) Investigators^&dagger ; ; Hugo Gonzá ; lez Saldivar ; Carlos Rodriguez-Pascual ; Teresa Parajes-Vazquez ; Marina Montero-Magan ; Gonzalo De la Morena ; Pedro J. Flores-Blanco ; Covadonga Ferná ; ndez-Golfí ; n ; Cristina Lozano ; Luis Miguel Rincó ; n ; Carmen Amoró ; s ; Xavier Borras ; Mario Baquero Alonso ; Eva Garcí ; a Camacho ; André ; s Sá ; nchez Pé ; rez ; Luis Martí ; nez Dolz ; Herminio Morillas Climent ; Jorge Sanz Sá ; nchez ; Marí ; a Ferré ; Vallverdú ; Albert Ariza Solé ; Gabriela Guzmá ; n-Martí ; nez ; Ó ; scar Gonzá ; lez-Ferná ; ndez ; Juan José ; Gó ; mez-Doblas ; Antonio Arribas Jimé ; nez ; Maria Jesú ; s Garcia Sá ; nchez ; Pedro Luis Sá ; nchez Fernandez ; Marí ; a Eugenia Fuentes ; Marí ; a Victoria Millá ; n ; Laura Galian Gay ; Martin Ruiz Ortiz ; Pablo Avanzas ; Isaac Pascual ; Cé ; sar Morí ; s ; Emad Abu-Assi ; Tomá ; s Ripoll Vera ; Yolanda Gó ; mez Pé ; rez ; Oscar Diaz-Castro ; Jesú ; s Jimenez Borreguero ; Eduardo Pozo ; Paula Antuñ ; a ; Dafne Viliani ; Marí ; a Victoria Mogolló ; n Jimé ; nez ; Gonzalo Marcos Gó ; mez ; Marcelino Corté ; s Garcí ; a ; Miguel Orejas Orejas ; Juan Quiles ; Clara Gunturiz ; Javier Castrodeza ; Javier Tobar ; Javier Ló ; pez ; Martin Jesú ; s Garcia Gonzalez ; Eva Bernal Labrador ; Jorge Ló ; pez Ayerbe ; Sonia Marí ; a Barros ; Antoni Carol Ruiz ; Javier Botas ; Alberto Nú ; ñ ; ez Garcí ; a ; Esther Sanz Girgas ; Alfredo Bardají ; Ruiz ; Cesar S. Caro Martinez ; Alicia Gó ; mez Aguera ; Teresa Pareja Sierra ; Fiorella Quinte Yarcuri ; Irene Mateo Rodriguez ; Maria del Pilar Zuazola Martí ; nez ; Teresa Pé ; rez ; Vicente Ignacio Arrarte Esteban ; Francisco Sogorb Garri ; Miguel A. Ramirez-Marrero ; Sonia Ibars Campañ ; a ; Ferrá ; n Padilla Marchan ; Jorge Rodrí ; guez-Capitá ; n ; Ramó ; n Andion ; Leopoldo Pé ; rez de Isla ; Patricia Mahí ; a Casado ; José ; Plaza Carrera ; Bernardo Garcí ; a de la Villa Redondo ; Fé ; lix M. Valencia-Serrano ; Daniel Bravo Bustos ; Isaac Lacambra-Blasco ; Guillermo Isasti ; Alicia Bautista Paves ; Eduardo Pereyra ; Eva Pueo ; Luis Cornide Santos ; Ana Garrido Martí ; n ; Clara Bonanad Lozano ; Javier Lopez Diaz ; Javier Castrodeza Calvo ; Javier Tobar Ruiz ; Manuel Martí ; nez-Sellé ; s
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 July 2016
• 年：2016
• 卷：118
• 期：2
• 页码：244-250
• 全文大小：532 K

文摘

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.