Hugo González Saldivar1, Lourdes Vicent Alaminos1, Carlos Rodríguez-Pascual2, Gonzalo de la Morena3, Covadonga Fernández-Golfín4, Carmen Amorós5, Mario Baquero Alonso6, Luis Martínez Dolz7, Albert Ariza Solé8, Gabriela Guzmán-Martínez9, Juan José Gómez-Doblas10, Antonio Arribas Jiménez11, María Eugenia Fuentes12, Laura Galian Gay13, Martín Ruiz Ortiz14, Pablo Avanzas15, Emad Abu-Assi16, Tomás Ripoll-Vera17, Oscar Díaz-Castro18, Eduardo Pozo Osinalde19, Eva Bernal20, Manuel Martínez-Sellés21. 1. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. 2. Servicio de Geriatría, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain. 3. Unidad de Imagen, Servicio de Cardiología, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain. 4. Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. 5. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6. Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain. 7. Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 8. Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 9. Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdIPaz), Madrid, Spain. 10. Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 11. Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain. 12. Servicio de Cardiología, Hospital Infanta Cristina, Badajoz, Spain. 13. Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 14. Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain. 15. Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 16. Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. 17. Servicio de Cardiología, Hospital Son Llàtzer, Instituto de Investigación Sanitaria de Palma (Idispa), Palma de Mallorca, Balearic Islands, Spain. 18. Servicio de Cardiología, Hospital de Pontevedra, Vigo, Pontevedra, Spain. 19. Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain. 20. Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 21. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain. Electronic address: mmselles@secardiologia.es.
Abstract
INTRODUCTION AND OBJECTIVES: Current therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months. METHODS: Subanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Diagnosis) registry in patients indicated for TAVI or SAVR. RESULTS: Of 726 patients with severe AS diagnosed in January 2014, the decision to perform an intervention was made in 300, who were included in the present study. The mean age was 74.0 ± 9.7 years. A total of 258 (86.0%) underwent an intervention: 59 TAVI and 199 SAVR. At the end of the year, 42 patients (14.0%) with an indication for an intervention did not receive it, either because they remained on the waiting list (34 patients) or died while waiting for the procedure (8 patients). Of the patients who died while on the waiting list, half did so in the first 100 days. The mean waiting time was 2.9 ± 1.6 for TAVI and 3.5 ± 0.2 months for SAVR (P = .03). The independent predictors of mortality were male sex (HR, 2.6; 95%CI, 1.1-6.0), moderate-severe mitral regurgitation (HR, 2.6; 95%CI, 1.5-4.5), reduced mobility (HR, 4.6; 95%CI, 1.7-12.6), and nonintervention (HR, 2.3; 95%CI, 1.02-5.03). CONCLUSIONS: Patients with severe aortic stenosis awaiting therapeutic procedures have a high mortality risk. Some clinical indicators predict a worse prognosis and suggest the need for early intervention.
INTRODUCTION AND OBJECTIVES: Current therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months. METHODS: Subanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Diagnosis) registry in patients indicated for TAVI or SAVR. RESULTS: Of 726 patients with severe AS diagnosed in January 2014, the decision to perform an intervention was made in 300, who were included in the present study. The mean age was 74.0 ± 9.7 years. A total of 258 (86.0%) underwent an intervention: 59 TAVI and 199 SAVR. At the end of the year, 42 patients (14.0%) with an indication for an intervention did not receive it, either because they remained on the waiting list (34 patients) or died while waiting for the procedure (8 patients). Of the patients who died while on the waiting list, half did so in the first 100 days. The mean waiting time was 2.9 ± 1.6 for TAVI and 3.5 ± 0.2 months for SAVR (P = .03). The independent predictors of mortality were male sex (HR, 2.6; 95%CI, 1.1-6.0), moderate-severe mitral regurgitation (HR, 2.6; 95%CI, 1.5-4.5), reduced mobility (HR, 4.6; 95%CI, 1.7-12.6), and nonintervention (HR, 2.3; 95%CI, 1.02-5.03). CONCLUSIONS:Patients with severe aortic stenosis awaiting therapeutic procedures have a high mortality risk. Some clinical indicators predict a worse prognosis and suggest the need for early intervention.