The impact of moderate aortic stenosis in acute myocardial infarction: A multicenter retrospective study

Abstract

Background Aortic stenosis (AS) is associated with myocardial ischemia through different mechanisms and may impair coronary arterial flow. However, data on the impact of moderate AS in patients with acute myocardial infarction (MI) is limited. Aims This study aimed to investigate the impact of moderate AS in patients presenting with acute myocardial infarction (MI). Methods We conducted a retrospective analysis of all patients who presented with acute MI to all Mayo Clinic hospitals, using the Enterprise Mayo PCI Database from 2005 to 2016. Patients were stratified into two groups: moderate AS and mild/no AS. The primary outcome was all cause mortality. Results The moderate AS group included 183 (13.3%) patients, and the mild/no AS group included 1190 (86.7%) patients. During hospitalization, there was no difference between both groups in mortality. Patients with moderate AS had higher in‐hospital congestive heart failure (CHF) (8.2% vs. 4.4%, p = 0.025) compared with mild/no AS patients. At 1‐year follow‐up, patients with moderate AS had higher mortality (23.9% vs. 8.1%, p < 0.001) and higher CHF hospitalization (8.3% vs. 3.7%, p = 0.028). In multivariate analysis, moderate AS was associated with higher mortality at 1‐year (odds ratio 2.4, 95% confidence interval [1.4–4.1], p = 0.002). In subgroup analyses, moderate AS increased all‐cause mortality in STEMI and NSTEMI patients. Conclusion The presence of moderate AS in acute MI patients was associated with worse clinical outcomes during hospitalization and at 1‐year follow‐up. These unfavorable outcomes highlight the need for a close follow‐up of these patients and for timely therapeutic strategies to best manage these coexisting conditions.

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“… 4 , 33 Furthermore, our findings are consistent with recent evidence suggesting that patients with AMI and moderate aortic stenosis (a more advanced stage of aortic valve degeneration) experience worse clinical outcomes at 1-year follow-up compared with those with mild or no aortic stenosis. 34 This adds further support to our observation that patients with AMI and AVSc are at increased risk of adverse cardiovascular outcomes.…”

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“…Even after catheter-based valve replacement, the rate of heart failure development was higher in patients with CAVD. Myocardial ischemia and myocardial infarction are also observed in untreated patients and have an overall worse prognosis than those without coexisting AS 67 . Emboli from calcified AV can lead to the development of embolic stroke in these patients.…”

Moderate aortic stenosis in patients with myocardial infarction: A guilty bystander?

“…Study" published in the Journal, Dr. Abraham and Colleagues provide further insight to this topic. 2 They report data of a multicenter, retrospective study aimed at evaluating the association between the presence of moderate AS and outcomes among patients with acute myocardial infarction (MI). Moderate AS was found in 13% of patients and was associated with two-fold incidence of in-hospital heart failure and higher 1-year mortality.…”

“…In the article entitled “The Impact of Moderate Aortic Stenosis in Acute Myocardial Infarction: A Multicenter Retrospective Study” published in the Journal , Dr. Abraham and Colleagues provide further insight to this topic 2 . They report data of a multicenter, retrospective study aimed at evaluating the association between the presence of moderate AS and outcomes among patients with acute myocardial infarction (MI).…”

“…Actually, the lower procedural risk resulting from recent technical advancements in aortic valve intervention is paving the way for early intervention in moderate AS patients with high‐risk features 4 . The study by Abraham et al 2 suggests that a recent MI could be one of such high‐risk feature. In fact, randomized controlled trials are ongoing to determine whether patients with moderate AS could benefit from invasive treatment instead of the watchful‐waiting approach recommended by the current guidelines 5 .…”