Abstract 20634: Outcomes of Medical Treatment for Aortic Stenosis in Japan
Introduction: Survival curves of aortic stenosis (AS) derived from 1960’s retrospective studies show that the interval between the onset of symptoms and the time of death is approximately 2 years in patients with heart failure, 3 years in those with syncope, and 5 years in those with angina. The overall 1-year survival rate of patients with severe aortic stenosis (AS) assigned to standard therapy without transcatheter aortic valve replacement in the PARTNER trial was approximately 50%.
Hypothesis: We hypothesized that the outcomes of patients with severe AS who were treated with medications improved compared with those of such patients in historical reports or selected candidates for randomized trials.
Methods: We retrospectively analyzed 139 AS patients who were managed conservatively and followed up for more than 3 years in 3 institutions in Japan between 2001 and 2012. The patients were categorized into the following 3 groups based on the initial symptoms: patients with symptoms of heart failure (Group A); patients with angina pectoris or syncope (Group B); and asymptomatic patients (Group C). The patients were also segregated into 3 groups according to AS severity on echocardiography. Severe AS was defined as a peak aortic-jet velocity of >4 m/s; moderate AS, as 3-4 m/s; and mild AS, as <3 m/s (mild group).
Results: The overall survival rate was significantly lower in Group A (67%) than in Group B (93%) and Group C (93%) (left upper panel; p < 0.001). Additionally, the event-free rate was significantly lower in Group A (50%) than in Group B (71%) and Group C (81%) (right upper panel; p < 0.001). With respect to AS severity, the overall survival rate or event rate among the groups did not significantly differ (lower panels).
Conclusions: Heart failure symptoms at presentation continue to influence patient outcomes. The outcomes of patients with severe AS who were treated without surgery or catheter interventions improved compared with those of such patients in historical reports.
Author Disclosures: E. Minamino: None. T. Kato: None. M. Inoko: None.
- © 2014 by American Heart Association, Inc.