Ullah, WU, Gowda, SG, Khan, MSK, Sattar, YS, Al-Khadra, YA, Rashid, MR, Mohamed, MOM, Alkhouli, MA, Kapadia, SK, Bagur, RB, Mamas, MA and Alraies, MCA (2020) Early intervention or watchful waiting for asymptomatic severe aortic stenosis: a systematic review and meta-analysis. European Heart Journal, 41 (S2). 1989 - 1989. ISSN 0195-668X

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Background The management of patients with severe but asymptomatic aortic stenosis (AS) is a challenge of daily practice. Evidence on early aortic valve replacement (AVR) versus symptom-driven approach is controversial. Methods Electronic databases were searched and articles comparing early-AVR with conservative management for severe asymptomatic AS were identified. The pooled unadjusted odds ratio (OR) was computed using a random-effects model. Results A total of 10 studies (observational=9, and randomized clinical trials=1) consisting of 5,291 patients were included. On a mean follow up duration of 4 years, the odds of early-AVR vs conservative management were in favour for early intervention in terms of cardiovascular mortality (OR 0.26, 95% CI 0.13–0.53, p=0.0002, figure-1) and all-cause mortality (OR 0.27, 95% CI: 0.17–0.41, p≤00001). The number needed to treat (NNT) by performing early AVR (either SAVR or TAVR) to prevent one death secondary to either cardiovascular or all-cause was 8 (95% CI: 6–10), and 5 (95% CI, 4.2–5.4) respectively. The odds of all-cause mortality in a selected patient population undergoing surgical AVR (SAVR) (OR 0.17, 95% CI 0.10–0.29, p≤0.00001) or transcatheter AVR (TAVR) (OR 0.45, 95% CI 0.31–0.64, p≤0.0001) were significantly lower compared to patients who were managed conservatively. A subgroup sensitivity analysis based on severe vs. very severe AS and early vs. symptom based AVR also mirrored the findings of overall results. Conclusions Patients with asymptomatic aortic valve stenosis have lower odds of all-cause and cardiovascular mortality when managed with early-AVR compared to conservative management.

Item Type: Article
Additional Information: This article can be obtained directly from the publisher at https://journals.lww.com/jcardiovascularmedicine/Abstract/2020/11000/Early_intervention_or_watchful_waiting_for.9.aspx
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 23 Apr 2021 10:16
Last Modified: 23 Apr 2021 10:16
URI: https://eprints.keele.ac.uk/id/eprint/9368

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