Aortic stenosis death spiral12/22/2023 In the present analysis, we (1) evaluated the cumulative incidence of all-cause, cardiac, and non-cardiac death during follow-up in the entire study population, (2) analyzed detailed causes of mortality according to the initial treatment strategies, and (3) determined the factors associated with non-cardiac mortality. Briefly, among the 3815 study patients, 1197 patients were managed with the initial aortic valve replacement (AVR) strategy, while 2618 patients were managed with the conservative strategy. The study design and patient enrollment in the registry were previously described in detail 9. We searched the hospital database for transthoracic echocardiography and enrolled consecutive patients who met the definition of severe AS on their index echocardiography (peak aortic jet velocity >4.0 m/s, mean aortic pressure gradient >40 mm Hg, or aortic valve area <1.0 cm 2) for the first time during the study period. The CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry enrolled 3815 consecutive patients with severe AS from 27 centers (on-site surgical facilities in 20 centers) in Japan between January 2003 and December 2011 (Appendix material) 9. The investigation of the causes of death can provide knowledge crucial to answer the question if the patients with AS die from AS-related causes or not, and how we should manage the patients in the era in which TAVI is becoming widely used. The present study aimed to investigate the cardiac and non-cardiac causes of death in patients with severe AS and to assess the associated factors with non-cardiac deaths in this cohort. Recently, we reported a multicenter observational registry characterized by the enrollment of all consecutive patients who met the criteria of severe AS in real clinical practice 9, 10. Theoretically, these patients are more likely to die because of non-cardiac causes. High risk surgical candidates no longer undergo classical surgery, but receive TAVI, as do inoperable patients 8. Although the natural course of AS is well known, there is limited literature on the exact causes of death in the population of patients with severe AS that was managed conservatively in the contemporary era 2, 7. Causes of death are often analyzed in selected cohorts, such as candidates for surgical aortic valve replacement, or in randomized controlled studies wherein the relatively strict enrollment criteria limit participation. In the PARTNER trial cohort B, the non-cardiovascular mortality rate was 43% at 2 years 5. In a systematic review, non-cardiac deaths accounted for approximately half of the mortalities beyond 30 days after transcatheter aortic valve implantation (TAVI) 6. In patients with AS who undergo surgical or transcatheter interventions, detailed causes of deaths have previously been reported 2, 3, 4, 5, 6. Older patients with AS have more comorbidities 1. AS predominantly affects the elderly because age-related degenerative changes are the main etiologies. These findings highlight the importance of close monitoring of non-cardiac comorbidities, as well as HF and sudden death, to improve the mortality rate of severe AS patients.Īortic stenosis (AS) is the most common valvular disease worldwide. Both non-cardiac factors (age, male, body mass index <22, diabetes, prior history of stroke, dialysis, anemia, and malignancy) and cardiac factors (atrial fibrillation, ejection fraction <68%, and the initial AVR strategy) were associated with non-cardiac death. According to treatment strategies, infection was the most common cause of non-cardiac death, followed by malignancy, in both the initial aortic valve replacement (AVR) cohort (N = 1197), and the conservative management cohort (N = 2618). Heart failure (HF) (25.7%) and sudden death (13.0%) caused the most cardiac deaths, whereas infection (13.0%) and malignancy (11.1%) were the main non-cardiac causes. We enrolled 3815 consecutive patients with a median follow-up of 1176 days the 1449 overall deaths comprised 802 (55.3%) from cardiac and 647 (44.7%) from non-cardiac causes. We used data from CURRENT AS registry, a Japanese multicenter registry, to assess the causes of death in severe AS patients and to identify the factors associated with non-cardiac mortality. Whether patients with severe aortic stenosis (AS) die because of AS-related causes is an important issue for the management of these patients. Scientific Reports volume 7, Article number: 14723 ( 2017) Causes of Death in Patients with Severe Aortic Stenosis: An Observational study
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