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)

Asymptomatic severe aortic stenosis: biomarkers are welcome

“…CURRENT-AS asymptomatic patients with BNP <100 pg/mL had a low event rate for ‘aortic valve-related death or heart failure hospitalisation’ (2% at 1 year), and those with BNP <300 pg/mL had a low rate of sudden death (1% at 1 year) and aortic valve-related death (2% at 1 year). This information is in alignment with the one reported by the Influencia del Diagnóstico de Estenosis Aórtica Severa —Influence of the Severe Aortic Stenosis Diagnosis registry,3 in which the mortality of patients receiving conservative treatment in the absence of significant symptoms was 2.9% at 1 year. Most patients with severe AS are elderly and present comorbidities, and transcatheter aortic valve implantation (TAVI) may be the treatment of choice in some of these cases.…”

Conservative management in very elderly patients with severe aortic stenosis: Time to change?

“…Probably this was a wise decision in these patients, since they had severe comorbidities, high risk for surgery, and higher one-year mortality, with a higher percentage of non-cardiac mortality as compared to other groups. Interestingly, data from the IDEAS registry [17] showed a high degree of agreement between the registry investigators and the treating medical team of patients when the reason for the conservative management was the presence of comorbidities (around 88%), in contrast to other settings. Patients from group V (other reasons) were probably comparable in terms of comorbidities (mean Charlson index 2.6), also with higher mortality as compared to groups II, III, and IV.…”

“…The IDEAS registry retrospectively included consecutive patients with AS [mean aortic gradient !40 mmHg or aortic valve area (AVA) <1 cm 2 by continuity equation [10], without previous valve intervention] diagnosed by echocardiography in 48 Spanish centers in January 2014 (n = 726) [17]. Clinical characteristics, echocardiographic data, Charlson comorbidity index [18], as well as European System for Cardiac Operative Risk Evaluation (EuroSCORE-II) [19] were registered.…”

“…However, little is known about the clinical profile and prognosis of symptomatic patients undergoing a conservative management in routine clinical practice [13,15,16]. The IDEAS study (Influencia del Diagnóstico de Estenosis Aórtica Severa) [17] is a multicenter Spanish registry, endorsed and coordinated by the Geriatric Cardiology Section of the Spanish Society of Cardiology which included consecutive patients with severe AS. This study was designed to assess the determinants of management and prognosis in these patients showing that most patients were managed conservatively (64.8%).…”

“…This study was designed to assess the determinants of management and prognosis in these patients showing that most patients were managed conservatively (64.8%). The most common reasons for this conservative management were the absence of symptoms (29.1%) and serious comorbidities (27.4%) [17].…”