Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.
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23/10/2015
23/10/2015
01/06/2014
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Resumo |
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. Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't; This work was supported as a sub-project (09-2007) by the Spanish National Centre for Cardiovascular Research (CNIC) - Scholarship for translational research and as a research project from the Cátedra Asisa-Universidad Europea de Madrid (UEM) (CAT001206C). |
Identificador |
Martínez-Sellés M, Gómez Doblas JJ, Carro Hevia A, García de la Villa B, Ferreira-González I, Alonso Tello A, et al. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J. Intern. Med.. 2014; 275(6):608-20 1365-2796 (Online) 0954-6820 (Print) http://hdl.handle.net/10668/2033 24320176 10.1111/joim.12174 |
Idioma(s) |
en |
Publicador |
Wiley |
Relação |
Journal of internal medicine http://onlinelibrary.wiley.com/doi/10.1111/joim.12174/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+Saturday%2C+7+June+from+10%3A00-15%3A00+BST+%2805%3A00-10%3A00+EDT%29+for+essential+maintenance |
Direitos |
Acceso abierto |
Palavras-Chave | #ageing #aortic stenosis #aortic surgery #Válvula aórtica #Fármacos cardiovasculares #Investigación sobre la eficacia comparativa #Evaluación geriátrica #Implantación de prótesis de válvulas cardíacas #Selección de paciente #Pronóstico #Estudios prospectivos #Índice de severidad de la enfermedad #Tasa de supervivencia #España #Anciano de 80 o más años #Estenosis de la válvula aórtica #Cateterismo cardíaco #Medical Subject Headings::Anatomy::Cardiovascular System::Heart::Heart Valves::Aortic Valve #Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Stenosis #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Catheterization::Heart Catheterization #Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents #Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Health Services Research::Comparative Effectiveness Research #Medical Subject Headings::Check Tags::Female #Medical Subject Headings::Health Care::Population Characteristics::Demography::Health Status::Geriatric Assessment #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Heart Valve Prosthesis Implantation #Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans #Medical Subject Headings::Check Tags::Male #Medical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Patient Selection #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies #Medical Subject Headings::Health Care::Health Services Administration::Organization and Administration::Records as Topic::Registries #Medical Subject Headings::Health Care::Health Services Administration::Organization and Administration::Risk Management::Risk Assessment::Risk Adjustment #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Health Status Indicators::Severity of Illness Index #Medical Subject Headings::Geographicals::Geographic Locations::Europe::Spain #Medical Subject Headings::Health Care::Population Characteristics::Demography::Vital Statistics::Mortality::Survival Rate #Medical Subject Headings::Health Care::Health Services Administration::Quality of Health Care::Outcome and Process Assessment (Health Care)::Outcome Assessment (Health Care)::Treatment Outcome #Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over |
Tipo |
info:eu-repo/semantics/article info:eu-repo/semantics/submitted Artículo |