Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

Korean Circulation Journal 2019년 49권 2호 p.160 ~ p.169

오진경(Oh Jin-Kyung) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
박재형(Park Jae-Hyeong) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
황진경(Hwang Jin-Kyung) - Veterans Health Service Medical Center Department of Internal Medicine
이창훈(Lee Chang-Hoon) - Veterans Health Service Medical Center Department of Internal Medicine
박종선(Park Jong-Seon) - Veterans Health Service Medical Center Department of Internal Medicine
박중일(Park Joong-Il) - Veterans Health Service Medical Center Department of Internal Medicine
박훈기(Park Hoon-Ki) - Veterans Health Service Medical Center Department of Internal Medicine
조정선(Cho Jung-Sun) - Catholic University College of Medicine Daejeon St. Mary’s Hospital Department of Internal Medicine
서봉석(Seo Bong-Suk) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
성석우(Seong Seok-Woo) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
선병주(Sun Byung-Joo) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
이재환(Lee Jae-Hwan) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
성인환(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±7 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±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, 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±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.

키워드

Aortic valve stenosis, Survival, Prognosis, Drug therapy
원문 및 링크아웃 정보
등재저널 정보
SCI(E) 학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
In elderly patients who treated medically, their 1-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
KCD코드
ICD 03
건강보험코드