Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
- Author:
Jin Kyung OH
1
;
Jae Hyeong PARK
;
Jin Kyung HWANG
;
Chang Hoon LEE
;
Jong Seon PARK
;
Joong Il PARK
;
Hoon Ki PARK
;
Jung Sun CHO
;
Bong suk SEO
;
Seok Woo SEONG
;
Byung Joo SUN
;
Jae Hwan LEE
;
In Whan SEONG
Author Information
- Publication Type:Original Article
- Keywords: Aortic valve stenosis; Survival; Prognosis; Drug therapy
- MeSH: Aged; Anemia; Aortic Valve Stenosis; Aortic Valve; Drug Therapy; Dyspnea; Follow-Up Studies; Humans; Hypertension; Mass Screening; Mortality; Multivariate Analysis; Natriuretic Peptide, Brain; Prognosis; Risk Factors; Stroke Volume
- From:Korean Circulation Journal 2019;49(2):160-169
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis. METHODS: From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR. RESULTS: After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78±7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p < 0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p < 0.001, p < 0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality. CONCLUSIONS: In elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.
