Abstract
We evaluated the clinical outcome of patients with moderate/severe aortic stenosis and significant coronary disease not treated according to guidelines, recommending combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). From 2002 to 2010, we assessed death up to 5 years in 650 patients with moderate/severe aortic stenosis and at least one coronary lesion (>50 %): 23 % were treated conservatively (MT), 17 % with percutaneous coronary intervention (PCI), 11 % with AVR, and 49 % with combined CABG and AVR. At a median follow-up of 58 months, overall death decreased over the groups (MT, 68 % vs. PCI, 44 % vs. AVR, 34 % vs. CABG and AVR, 23 %, p < 0.01). Compared to the MT group, Cox regression analysis adjusted for potential confounders showed significantly reduced mortality in the PCI, AVR, and CABG and AVR groups. When combined CABG and AVR is not feasible, PCI or AVR alone still improves significantly long-term survival as compared with MT alone.
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Abbreviations
- AS:
-
Aortic stenosis
- AVR:
-
Aortic valve replacement
- AVA:
-
Aortic valve area
- CABG:
-
Coronary artery bypass grafting
- CAD:
-
Coronary artery disease
- DES:
-
Drug-eluting stents
- LVEF:
-
Left ventricular ejection fraction
- MT:
-
Medical therapy
- PCI:
-
Percutaneous coronary intervention
- TAVR:
-
Transcatheter aortic valve replacement
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The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (revised in 2000) as reflected in a priori approval by the institutional medical ethics committee. Informed consent was obtained from each patient.
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Associate Editor Angela Taylor oversaw the review of this article
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Di Gioia, G., Pellicano, M., Toth, G.G. et al. Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. J. of Cardiovasc. Trans. Res. 9, 145–152 (2016). https://doi.org/10.1007/s12265-016-9680-6
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DOI: https://doi.org/10.1007/s12265-016-9680-6