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Title: Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.
Authors: Martínez-Sellés, M
Gómez Doblas, J J
Carro Hevia, A
García de la Villa, B
Ferreira-González, I
Alonso Tello, A
Andión Ogando, R
Ripoll Vera, T
Arribas Jiménez, A
Carrillo, P
Rodríguez Pascual, C
Casares i Romeva, M
Borras, X
Cornide, L
López-Palop, R
metadata.dc.contributor.authoraffiliation: [Martínez-Sellés,M] Servicio de Cardiología, Hospital General Universitario Gregorio Marañón. Universidad Europea de Madrid, Madrid, Spain. [Gómez Doblas,JJ] Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. [Carro Hevia,A] Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain. [García de la Villa,B] Servicio de Cardiología, Hospital de Manacor, Mallorca, Spain. [Ferreira-González,I] Unidad de Epidemiología del Servicio de Cardiología, Hospital Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP) y Universitat Autónoma de Barcelona, Spain. [Alonso Tello,A] Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. [Andión Ogando,R] Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain. [Ripoll Vera,T] Servicio de Cardiología, Fundación Hospital Son Llatzer, Palma de Mallorca, Spain. [Arribas Jiménez,A] Servicio de Cardiología, Hospital Clínico Universitario, Salamanca, Spain. [Carrillo,P; López-Palop,R] Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Spain. [Rodríguez Pascual] Servicio de Geriatría, Complejo Hospitalario Universitario do Meixoeiro, Vigo, Spain. [Casares i Romeva,M] Servicio de Cardiología, Hospital Plató, Barcelona, Spain. [Borras,X] Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. [Cornide,L] Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Spain. PEGASO Registry Group
Keywords: Ageing;Aortic stenosis;Aortic surgery;Anciano de 80 o más años;Estenosis de la válvula aórtica;Implantación de prótesis de válvulas cardíacas;Cateterismo cardíaco;Causas de muerte;Pronóstico
metadata.dc.subject.mesh: Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over
Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Stenosis
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Heart Valve Prosthesis Implantation
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Catheterization::Heart Catheterization
Medical Subject Headings::Information Science::Information Science::Data Collection::Vital Statistics::Mortality::Cause of Death
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Issue Date: Jun-2014
Publisher: Wiley
Citation: Martínez-Sellés M, Gómez Doblas JJ, Carro Hevia A, García de la Villa B, Ferreira-González I, Alonso Tello A, et al. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J. Intern. Med.. 2014 ; 275(6):608-20
Abstract: OBJECTIVE To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING Transnational registry in Spain. SUBJECTS We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES All-cause death. RESULTS Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
Description: Journal Article;
metadata.dc.identifier.doi: 10.1111/joim.12174
ISSN: 1365-2796 (Online)
0954-6820 (Print)
Appears in Collections:01- Artículos - Hospital Virgen de la Victoria

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