Document Detail


Clinical outcome of asymptomatic severe aortic stenosis with medical and surgical management: importance of STS score at diagnosis.
MedLine Citation:
PMID:  21095330     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Society of Thoracic Surgeons (STS) score aims at predicting operative mortality in cardiac surgery. The value of this score in predicting short- and long-term survival with medical or surgical management in patients with asymptomatic severe aortic stenosis (AS) is unknown.
METHODS: In a cohort of 694 patients (aged 71 ± 11 years) with isolated, asymptomatic severe AS (velocity ≥4 m/s), STS score was calculated at baseline and its link to survival analyzed. Patients were stratified by STS score less than 4%, 4% to 6.5%, and 6.5% or greater.
RESULTS: The STS score showed no association with operative mortality within 1 year of diagnosis or any time (1%, 2.9%, and 6.1%, respectively, by strata; p = 0.08) and a weak association with 1-year survival (p = 0.04). Conversely, long-term survival (10-year) was strongly predicted by STS score strata (78%, 47%, and 16%, respectively; p < 0.0001). In multivariate analysis, STS score independently predicted mortality (hazard ratio/1%, 1.15 [1.12 to 1.18], p < 0.0001) or cardiac death (1.21 [1.17 to 1.25], p < 0.0001). Aortic valve replacement within 1 year of diagnosis markedly improved survival (adjusted hazard ratio, 0.58, p < 0.001). However, benefit of early surgery varied according to strata, with no overt benefit with low score (p = 0.83), whereas early surgery considerably improved survival in the intermediate strata (p < 0.001).
CONCLUSIONS: For patients with asymptomatic severe AS, STS score is a powerful tool for predicting long-term outcome and for selecting patients (particularly those at intermediate risk) who benefit markedly from early surgery. Hence, risk-scoring using STS score should be routinely performed in patients with AS to support the clinical decision-making process.
Authors:
Thierry Le Tourneau; Patricia A Pellikka; Morgan L Brown; Joseph F Malouf; Douglas W Mahoney; Hartzell V Schaff; Maurice Enriquez-Sarano
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1876-83     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiovascular Diseases and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Stenosis / diagnosis*,  mortality,  therapy
Balloon Dilation / methods*
Blood Flow Velocity / physiology
Cause of Death / trends
Echocardiography, Doppler
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation / methods*
Humans
Male
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Rate / trends
United States / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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