Published in:
Open Access
01-12-2015 | Research
Does treatment assignment influence the prognosis of patients with symptomatic severe aortic stenosis?
Authors:
Giovanni Cioffi, Cesare Tomasi, Andrea Rossi, Stefano Nistri, Luigi Tarantini, Giacomo Faden, Carmine Mazzone, Andrea Di Lenarda, Federica Ettori, Carlo Stefenelli, Pompilio Faggiano
Published in:
Cardiovascular Ultrasound
|
Issue 1/2015
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Abstract
Objective
Aortic valve replacement (AVR) is the standard therapy in patients with symptomatic aortic stenosis (AS). In high surgical risk patients, alternative therapeutic options to medical treatment (MT) such as trans-catheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) have been proposed. In this study we evaluated whether treatment assignment influences per se the prognosis of these subjects.
Patients and methods
Criteria for treatment assignment were based on patient’s clinical conditions, Logistic EuroSCORE and other co-morbidities ignored by EuroSCORE. Due to baseline clinical differences between patients with diverse treatment assignment, we used propensity score matching to achieve balance.
Results
368 patients were studied: 141 underwent AVR, 127 TAVI, 49 BAV and 51 MT. 84 events (deaths for all causes) occurred during 14 months of follow-up: 11 AVR (8%), 26 TAVI (20%), 18 MT (35%), 29 BAV group (59%). Traditional Cox analysis identified treatment assignment as independent predictor of events (HR 1.82 [CI 1.10-3.25]) together with lower left ventricular ejection fraction, impaired renal function and history of heart failure. Matched Cox analysis by propensity score confirmed treatment assignment as an independent prognosticator of events (HR 1.90 [CI 1.27-2.85]), and showed similar rate events in TAVI and AVR patients, while it was significantly increased in BAV and MT patients.
Conclusions
Treatment assignment may influence outcome of symptomatic patients with AS.