Abstract 12885: Systolic Dysfunction in Aortic Stenosis as a Predictive Factor for Acute Coronary Syndromes and Survival. A Prospective Clinical Study
Introduction: Patients with preexistent aortic valve disease represent approximately 5% of the total number of patients with acute coronary syndrome (ACS). They have high cardiovascular risk and poor prognosis.
Methods and results: A group of 196 patients, age from 56 to 94, having different degrees of degenerative AS, was followed up over a 5-year period. 54 of them (27.6%) developed ACS in the follow-up period. A number of 67 patients (34.2%) had left ventricular (LV) systolic dysfunction, 11 had LV severe systolic dysfunction (5.6%), defined by ejection fraction (EF) under 30% (7 from the ACS group), 28 had moderate systolic dysfunction (14.28%), defined by EF between 30-40% (14 from the ACS group) and 28 had mild systolic dysfunction (14.28%), defined by EF between 40-50% (8 from ACS group). Survival data were performed with Kaplay-Meier method and with logrank test. Cox proportional hazard regression was performed to check the differences between groups. The ACS group has a smaller median EF compared to the non ACS group (43% vs. 51%) obtaining p<0.001. The risk of developing ACS was very high at patients with AS and systolic dysfunction (p=0.0016, OR 2.84, 95% CI 1.48-5.44). It was tested the probability of survival according to EF, obtaining p<0.001. The three groups of systolic dysfunction were compared with normal EF group and were obtained the following hazard ratios (HR):
4.97 (95% CI 2.16-11.42) in severe systolic dysfunction group
2.03 (95% CI 0.8-5.17) in moderate systolic dysfunction group
1.92 (95% CI 0.78-4.7) in mild systolic dysfunction group
The probability of survival at 5 years was 77.5% for those without systolic dysfunction (70.3-85.5) and 30% for those with severe systolic dysfunction (11.6-77.3).
Conclusion: Patients with degenerative AS and left ventricular systolic dysfunction have an increased risk of developing ACS and a high risk of mortality. It is of top priority to identify these patients and to establish an optimal medical/interventional/surgical therapeutic care in order to achieve a better prognosis, aggravated by the increased incidence of ACS. The study brings new prognostic evidences on the less studied evolution of patients with degenerative AS in respect of the occurrences of ACS.
- © 2012 by American Heart Association, Inc.