Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement
Objective Severe aortic stenosis (AS) is one of the most serious valve conditions. Patient demography and the aetiology of AS have substantially changed in the past several decades along with a drastic improvement of surgical aortic valve replacement (SAVR) and its associated procedures. Contemporar...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-05-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/6/1/e000992.full |
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| author | Kenji Ando Shinichi Shirai Shiro Miura Takehiro Yamashita Michiya Hanyu Hiraku Kumamaru |
| author_facet | Kenji Ando Shinichi Shirai Shiro Miura Takehiro Yamashita Michiya Hanyu Hiraku Kumamaru |
| author_sort | Kenji Ando |
| collection | DOAJ |
| description | Objective Severe aortic stenosis (AS) is one of the most serious valve conditions. Patient demography and the aetiology of AS have substantially changed in the past several decades along with a drastic improvement of surgical aortic valve replacement (SAVR) and its associated procedures. Contemporary patients with severe AS have multiple comorbidities and live much longer. We aimed to elucidate the treatment effects of SAVR on long-term outcome in propensity score (PS)-matched and the entire patient populations.Methods We retrospectively reviewed 570 patients with severe AS defined as an aortic valve area of 1.0 cm2 or less. Systemic differences in 39 baseline characteristics between non-SAVR and SAVR groups were adjusted using PS matching method. The endpoints included all-cause mortality and cardiovascular events that included heart failure, non-fatal stroke, syncope and acute coronary syndrome.Results Overall, 55% of the entire population (mean age 78 years; males 41%) were symptomatic. During 3.9 years of the median follow-up, 210 (36%) patients underwent SAVR and 231 (41%) died. Cumulative incidences of mortality and both mortality and cardiovascular events were significantly higher in the non-SAVR group than in the other group (p<0.001, each). Among 101 PS-matched pairs, SAVR correlated with a lower mortality risk (HR 0.35; 95% CI 0.21 to 0.59; p<0.001)) and mortality and cardiovascular events combined (HR 0.62; 95% CI 0.42 to 0.92; p=0.02). However, survival difference between both groups was markedly smaller among asymptomatic patients in the subgroup of matched patients.Conclusion Patients with AS undergoing SAVR exhibit a lower incidence of all-cause mortality and major cardiovascular events than those not undergoing surgical interventions, even after the baseline characteristics are balanced by the PS matching. The correlation between SAVR and survival from cardiovascular events is less evident among asymptomatic patients. |
| format | Article |
| id | doaj-art-94c67af5d56d47c59e4bfdb1f3f42128 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-94c67af5d56d47c59e4bfdb1f3f421282024-11-12T11:45:10ZengBMJ Publishing GroupOpen Heart2053-36242019-05-016110.1136/openhrt-2018-000992Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacementKenji Ando0Shinichi Shirai1Shiro Miura2Takehiro Yamashita3Michiya Hanyu4Hiraku Kumamaru5Department of Cardiology, Kokura Memorial Hospital, Fukuoka, JapanDepartment of Cardiology, Kokura Memorial Hospital, Kitakyushu, JapanDepartment of Cardiology, Hokkaido Ono Memorial Hospital, Sapporo, JapanDepartment of Cardiology, Hokkaido Ono Memorial Hospital, Sapporo, JapanCardiovascular Centre, Tazuke Kofukai Foundation Medical Research Institute, Kitano Hospital, Osaka, JapanDepartment of Clinical Epidermiology, Tokyo University, Tokyo, JapanObjective Severe aortic stenosis (AS) is one of the most serious valve conditions. Patient demography and the aetiology of AS have substantially changed in the past several decades along with a drastic improvement of surgical aortic valve replacement (SAVR) and its associated procedures. Contemporary patients with severe AS have multiple comorbidities and live much longer. We aimed to elucidate the treatment effects of SAVR on long-term outcome in propensity score (PS)-matched and the entire patient populations.Methods We retrospectively reviewed 570 patients with severe AS defined as an aortic valve area of 1.0 cm2 or less. Systemic differences in 39 baseline characteristics between non-SAVR and SAVR groups were adjusted using PS matching method. The endpoints included all-cause mortality and cardiovascular events that included heart failure, non-fatal stroke, syncope and acute coronary syndrome.Results Overall, 55% of the entire population (mean age 78 years; males 41%) were symptomatic. During 3.9 years of the median follow-up, 210 (36%) patients underwent SAVR and 231 (41%) died. Cumulative incidences of mortality and both mortality and cardiovascular events were significantly higher in the non-SAVR group than in the other group (p<0.001, each). Among 101 PS-matched pairs, SAVR correlated with a lower mortality risk (HR 0.35; 95% CI 0.21 to 0.59; p<0.001)) and mortality and cardiovascular events combined (HR 0.62; 95% CI 0.42 to 0.92; p=0.02). However, survival difference between both groups was markedly smaller among asymptomatic patients in the subgroup of matched patients.Conclusion Patients with AS undergoing SAVR exhibit a lower incidence of all-cause mortality and major cardiovascular events than those not undergoing surgical interventions, even after the baseline characteristics are balanced by the PS matching. The correlation between SAVR and survival from cardiovascular events is less evident among asymptomatic patients.https://openheart.bmj.com/content/6/1/e000992.full |
| spellingShingle | Kenji Ando Shinichi Shirai Shiro Miura Takehiro Yamashita Michiya Hanyu Hiraku Kumamaru Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement Open Heart |
| title | Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement |
| title_full | Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement |
| title_fullStr | Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement |
| title_full_unstemmed | Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement |
| title_short | Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement |
| title_sort | propensity score matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement |
| url | https://openheart.bmj.com/content/6/1/e000992.full |
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