Moderate-to-severe aortic stenosis tied to poor survival when left untreated

Long-term mortality remains high in patients with untreated severe aortic stenosis (AS), suggests a study. Those with moderate AS also have poor survival rates.

Of the patients, 16,129 (6.7 percent), 3,315 (1.4 percent) and 6,383 (2.6 percent) had mild, moderate and severe AS, respectively.

On an adjusted basis (compared with no AS; 5-year mortality, 19 percent), an increasing risk of long-term mortality was observed in patients with mild to severe AS (adjusted hazard ratio, 1.44–2.09; p<0.001 for all comparisons).

Patients with moderate AS (mean gradient, 20.0–39.0 mm Hg or peak velocity, 3.0–3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or aortic valve area <1.0 cm² in low-flow, low-gradient severe AS) had a corresponding 5-year mortality of 56 percent and 67 percent.

After adjusting for age, sex, aortic regurgitation, and left ventricular systolic or diastolic dysfunction, a significant increase in risk of death from all causes (5-year mortality >50 percent) and cardiovascular disease was observed in patients with moderate AS (mean aortic valve gradient >20.0 mm Hg).

This study characterized AS severity by convention and by statistical distribution in 122,809 male patients (mean age, 61 years) and 118,494 female patients (mean age, 62 years), with measured aortic valve mean gradient, peak velocity and/or area.

The authors assessed the association between AS severity and survival during a median follow-up of 1,208 days (interquartile range, 598–2,177 days). Patients with previous aortic valve intervention were not included in the analysis.

“Historical data suggesting poor survival in patients with AS who do not undergo treatment are largely confined to patients with severe AS,” the authors noted.