Manuel Martínez-Sellés1, Pablo Díez-Villanueva2, Domingo Sánchez-Sendin2, Amelia Carro Hevia3, Juan José Gómez Doblas4, Bernardo García de la Villa5, Luis Cornide6, Albert Alonso Tello7, Ramón Andión Ogando8, Tomás Ripoll Vera9, Antonio Arribas Jiménez10, Pilar Carrillo11, Carlos Rodríguez Pascual12, Maria Casares I Romeva13, Xavier Borras14, Sandra Vázquez2, Ramón López-Palop11. 1. Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid y Universidad Europea de Madrid, Spain. Electronic address: mmselles@secardiologia.es. 2. Hospital General Universitario Gregorio Marañón, Madrid, Spain. 3. Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain. 4. Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. 5. Servicio de Cardiología, Hospital de Manacor, Mallorca, Spain. 6. Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Madrid, Spain. 7. Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 8. Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain. 9. Servicio de Cardiología, Hospital Son Llatzer, Palma de Mallorca, Spain. 10. Servicio de Cardiología, Hospital Clínico Universitario, Salamanca, Spain. 11. Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain. 12. Servicio de Geriatría, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain. 13. Servicio de Cardiología, Hospital Plató, Barcelona, Spain. 14. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Abstract
BACKGROUND: The benefit from intervention in elderly patients with symptomatic severe aortic stenosis (AS) and high comorbidity is unknown. Our aims were to establish the correlation between the Charlson comorbidity index and the prognosis of octogenarians with symptomatic sever AS and to identify patients who might not benefit from intervention. METHODS: We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario--Prognosis of symptomatic severe aortic stenosis in octogenarians), a prospective registry that included consecutively 928 patients aged ≥ 80 years with severe symptomatic AS. RESULTS: The mean Charlson comorbidity index was 3.0 ± 1.7, a total of 151 patients (16.3%) presented high comorbidity (index ≥ 5). Median survival was lower for patients with high comorbidity than for those without (16.7 ± 1.2 vs. 26.5 ± 0.6 months, p < 0.001). In patients without high comorbidity planned interventional management was clearly associated with prognosis (log rank p < 0.001), which was not the case in patients with high comorbidity (log rank p > 0.10). In multivariate analysis, the only variables that were independently associated with prognosis were planned medical management and Charlson index. Patients with high comorbidity presented non-cardiac death more frequently than those who had not (28.6% vs. 19.5%, p = 0.008). CONCLUSIONS: One sixth of octogenarians with symptomatic severe AS have very high comorbidity (Charlson index ≥ 5). These patients have a poor prognosis in the short term and do not seem to benefit from interventional treatment.
BACKGROUND: The benefit from intervention in elderly patients with symptomatic severe aortic stenosis (AS) and high comorbidity is unknown. Our aims were to establish the correlation between the Charlson comorbidity index and the prognosis of octogenarians with symptomatic sever AS and to identify patients who might not benefit from intervention. METHODS: We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario--Prognosis of symptomatic severe aortic stenosis in octogenarians), a prospective registry that included consecutively 928 patients aged ≥ 80 years with severe symptomatic AS. RESULTS: The mean Charlson comorbidity index was 3.0 ± 1.7, a total of 151 patients (16.3%) presented high comorbidity (index ≥ 5). Median survival was lower for patients with high comorbidity than for those without (16.7 ± 1.2 vs. 26.5 ± 0.6 months, p < 0.001). In patients without high comorbidity planned interventional management was clearly associated with prognosis (log rank p < 0.001), which was not the case in patients with high comorbidity (log rank p > 0.10). In multivariate analysis, the only variables that were independently associated with prognosis were planned medical management and Charlson index. Patients with high comorbidity presented non-cardiac death more frequently than those who had not (28.6% vs. 19.5%, p = 0.008). CONCLUSIONS: One sixth of octogenarians with symptomatic severe AS have very high comorbidity (Charlson index ≥ 5). These patients have a poor prognosis in the short term and do not seem to benefit from interventional treatment.
Authors: Laura Flannery; Muhammad Etiwy; Alexander Camacho; Ran Liu; Nilay Patel; Arpi Tavil-Shatelyan; Varsha K Tanguturi; Jacob P Dal-Bianco; Evin Yucel; Rahul Sakhuja; Arminder S Jassar; Nathaniel B Langer; Ignacio Inglessis; Jonathan J Passeri; Judy Hung; Sammy Elmariah Journal: J Am Heart Assoc Date: 2022-05-27 Impact factor: 6.106