Death and Interventional Cardiology: A Tale of Two Trials
In this issue of Circulation, the 3 year follow up of the PARTNER B trial provides us with a sobering final word on the natural history of severe aortic stenosis1. As described 50 years ago, severe aortic stenosis is a terminal illness of the elderly with a progression from symptoms to death over an approximately 3 year period2, 3. The current report of the 3 year follow up from the PARTNER B trial confirms this dismal natural history: among patients randomized to standard therapy in the initial trial and/or continued access study, 81% are dead after 3 years. Transcatheter aortic valve replacement (TAVR) alters this natural history significantly, providing a 47% reduction in the risk of death over 3 years (HR 0.53, 95% confidence interval 0.41-0.68, p < 0.001). Based upon this demonstration of effective therapy for even surgically inoperable patients, the natural history studies of untreated severe aortic stenosis are complete.
- Received August 22, 2014.
- Accepted August 25, 2014.