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

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 Decem...

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Autores principales: Oh, Jin Kyung, Park, Jae-Hyeong, Hwang, Jin Kyung, Lee, Chang Hoon, Park, Jong Seon, Park, Joong-Il, Park, Hoon-Ki, Cho, Jung Sun, Seo, Bong-suk, Seong, Seok-Woo, Sun, Byung Joo, Lee, Jae-Hwan, Seong, In-Whan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351279/
https://www.ncbi.nlm.nih.gov/pubmed/30468030
http://dx.doi.org/10.4070/kcj.2018.0208
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author Oh, Jin Kyung
Park, Jae-Hyeong
Hwang, Jin Kyung
Lee, Chang Hoon
Park, Jong Seon
Park, Joong-Il
Park, Hoon-Ki
Cho, Jung Sun
Seo, Bong-suk
Seong, Seok-Woo
Sun, Byung Joo
Lee, Jae-Hwan
Seong, In-Whan
author_facet Oh, Jin Kyung
Park, Jae-Hyeong
Hwang, Jin Kyung
Lee, Chang Hoon
Park, Jong Seon
Park, Joong-Il
Park, Hoon-Ki
Cho, Jung Sun
Seo, Bong-suk
Seong, Seok-Woo
Sun, Byung Joo
Lee, Jae-Hwan
Seong, In-Whan
author_sort Oh, Jin Kyung
collection PubMed
description 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 cm(2) 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.
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spelling pubmed-63512792019-02-09 Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement Oh, Jin Kyung Park, Jae-Hyeong Hwang, Jin Kyung Lee, Chang Hoon Park, Jong Seon Park, Joong-Il Park, Hoon-Ki Cho, Jung Sun Seo, Bong-suk Seong, Seok-Woo Sun, Byung Joo Lee, Jae-Hwan Seong, In-Whan Korean Circ J Original Article 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 cm(2) 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. The Korean Society of Cardiology 2018-10-26 /pmc/articles/PMC6351279/ /pubmed/30468030 http://dx.doi.org/10.4070/kcj.2018.0208 Text en Copyright © 2019. The Korean Society of Cardiology https://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Oh, Jin Kyung
Park, Jae-Hyeong
Hwang, Jin Kyung
Lee, Chang Hoon
Park, Jong Seon
Park, Joong-Il
Park, Hoon-Ki
Cho, Jung Sun
Seo, Bong-suk
Seong, Seok-Woo
Sun, Byung Joo
Lee, Jae-Hwan
Seong, In-Whan
Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
title Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
title_full Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
title_fullStr Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
title_full_unstemmed Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
title_short Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement
title_sort long-term survival in korean elderly patients with symptomatic severe aortic stenosis who refused aortic valve replacement
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351279/
https://www.ncbi.nlm.nih.gov/pubmed/30468030
http://dx.doi.org/10.4070/kcj.2018.0208
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