No impact seen on primary outcome among patients with asymptomatic severe aortic stenosis, myocardial fibrosis
By Elana Gotkine HealthDay Reporter
THURSDAY, Oct. 31, 2024 (HealthDay News) — For patients with asymptomatic severe aortic stenosis and myocardial fibrosis, early aortic valve intervention does not impact all-cause death or unplanned aortic stenosis-related hospitalization compared with guideline-directed conservative management, according to a study published online Oct. 28 in the Journal of the American Medical Association to coincide with the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to 30 in Washington, D.C.
Krithika Loganath, M.D., from the University of Edinburgh in the United Kingdom, and colleagues examined whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis in a trial conducted at 24 cardiac centers. A total of 224 eligible patients were enrolled and randomly assigned to receive early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management (113 and 111 patients, respectively).
The researchers found that the primary end point (composite of all-cause death or unplanned aortic stenosis-related hospitalization) occurred in 18 and 23 percent of patients in the early intervention and guideline-directed conservative management groups, respectively (hazard ratio [HR], 0.79; 95 percent confidence interval [CI], 0.44 to 1.43). No significant difference was seen in seven of nine prespecified secondary end points. All-cause death occurred in 14 and 13 percent of patients in the early-intervention and guideline-directed groups, respectively (HR, 1.22; 95 percent CI, 0.59 to 2.51). Unplanned aortic stenosis hospitalization occurred in 6 and 17 percent, respectively (HR, 0.37; 95 percent CI, 0.16 to 0.88).
“There was no demonstrable difference in the primary composite end point of all-cause mortality or unplanned aortic stenosis-related hospitalization,” the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
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