Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
Korean Circulation Journal 2019³â 49±Ç 2È£ p.160 ~ p.169
¿ÀÁø°æ(Oh Jin-Kyung) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
¹ÚÀçÇü(Park Jae-Hyeong) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
ȲÁø°æ(Hwang Jin-Kyung) - Veterans Health Service Medical Center Department of Internal Medicine
ÀÌâÈÆ(Lee Chang-Hoon) - Veterans Health Service Medical Center Department of Internal Medicine
¹ÚÁ¾¼±(Park Jong-Seon) - Veterans Health Service Medical Center Department of Internal Medicine
¹ÚÁßÀÏ(Park Joong-Il) - Veterans Health Service Medical Center Department of Internal Medicine
¹ÚÈƱâ(Park Hoon-Ki) - Veterans Health Service Medical Center Department of Internal Medicine
Á¶Á¤¼±(Cho Jung-Sun) - Catholic University College of Medicine Daejeon St. Mary¡¯s Hospital Department of Internal Medicine
¼ºÀ¼®(Seo Bong-Suk) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
¼º¼®¿ì(Seong Seok-Woo) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
¼±º´ÁÖ(Sun Byung-Joo) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
ÀÌÀçȯ(Lee Jae-Hwan) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
¼ºÀÎȯ(Seong In-Whan) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
Abstract
Background and Objectives: Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis.
Methods: From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR.
Results: After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78¡¾7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73¡¾0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8¡¾12.2%. Total 102 patients died during follow-up period (39.1¡¾31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1¡¾3.0%, 43.1¡¾3.8%, and 56.5¡¾4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0¡¾2.9%, 38.2¡¾3.8%, and 50.7¡¾4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p<0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p<0.001, p<0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality.
Conclusions: In elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1¡¾3.0%, 43.1¡¾3.8%, and 56.5¡¾4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.
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Aortic valve stenosis, Survival, Prognosis, Drug therapy
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À¯È¿¼º°á°ú(Recomendation)
In elderly patients who treated medically, their 1-, 3-, and 5-year all-cause mortality rate was 21.1¡¾3.0%, 43.1¡¾3.8%, and 56.5¡¾4.2%, respectively and 1-, 3-, and 5-year cardiac mortality rate was 18.0¡¾2.9%, 38.2¡¾3.8%, and 50.7¡¾4.3%, respectively.