In patients with heart attack, moderate aortic stenosis worsens outcomes at 1 year
Click Here to Manage Email Alerts
Key takeaways:
- Patients with acute heart attack and moderate aortic stenosis were at greater risk for new-onset heart failure during hospitalization.
- Moderate aortic stenosis was associated with higher 1-year mortality.
Adults with acute MI who also had moderate aortic stenosis were more likely to develop HF during hospitalization and die during the first year of follow-up compared with patients with MI and mild or no aortic stenosis, researchers reported.
“It has been demonstrated that the presence of severe aortic valve disease can complicate the clinical prognosis in patients with a MI, but data on the impact of moderate aortic stenosis in the setting of an ACS is lacking,” Bishoy Abraham, MD, a cardiology fellow at Mayo Clinic Hospital in Phoenix, and colleagues wrote in the study background. “Moreover, current guidelines do not provide specific recommendations for the management of aortic stenosis in patients with ACS. Recent publications suggest poor survival rates in patients with isolated moderate aortic stenosis, thus potential early interventions of these patients are under study.”
Image: Adobe Stock
In a retrospective study, Abraham and colleagues analyzed data from 1,373 patients who presented with acute MI to all Mayo Clinic hospitals from 2005 to 2016. Researchers stratified patients into moderate aortic stenosis (n = 183) and mild/no aortic stenosis (n = 1,190) groups. The primary outcome was all-cause mortality.
The findings were published in Catheterization and Cardiovascular Interventions.
Within the two groups, those with moderate aortic stenosis were older (mean age, 77 years vs. 67 years; P < .001), and were more likely to have diabetes (37.2% vs. 28.2%; P = .014), hypertension (87.4% vs. 75.7%; P < .001), previous MI (31.2% vs. 20.3%; P = .001), prior CABG (25.1% vs. 10.7%; P < .001) and previous stroke (18.6% vs. 10.8%; P = .002) compared with patients with mild or no aortic stenosis.
During hospitalization, there was no mortality difference between groups.
Compared with patients who had mild or no aortic stenosis, those with moderate aortic stenosis had higher in‐hospital congestive HF (4.4% vs. 8.2%; P = .025). At 1‐year follow‐up, patients with moderate aortic stenosis had higher mortality compared with those with mild or no aortic stenosis (23.9% vs. 8.1%; P < .001) as well as higher congestive HF hospitalization (8.3% vs. 3.7%; P = .028).
In multivariate analysis, moderate aortic stenosis was associated with more than twofold odds of mortality at 1 year (OR = 2.4; 95% CI, 1.4-4.1; P = .002). In subgroup analyses, moderate aortic stenosis increased all‐cause mortality in patients with STEMI and in those with non-STEMI.
The researchers noted that the small sample size of the moderate aortic stenosis group could have affected the results of the analysis.
“Therefore, the association between moderate aortic stenosis and mortality in this setting should ideally be confirmed by prospective studies,” the researchers wrote.
Collapse
Read more about
Click Here to Manage Email Alerts