Causes of Death in Patients with Severe Aortic Stenosis: An Observational study

Eri Minamino‐Muta ,Takeshi Morimoto,Yoshihiro Kato,Makoto Miyake,Takeshi Kitai,Eiji Tada,Kenji Minatoya,Keisuke Nagao ,Kozo Hotta,Takao Kato,Shintaro Matsuda,Takeshi Kimura,Kenji Ando,Katsuyuki Murata ,Mitsuru Ishii,Akihiro Komasa,Tomoyuki Ikeda,Norio Kanamori,Tomohiko Taniguchi,Chisato Izumi,Moriaki Inoko,Yasuhiro Morikami ,Hirokazu Mitsuoka,Mamoru Toyofuku,Yutaka Hirano,Tsukasa Inada,Hiroki Shiomi,Nobuya Higashitani,Masashi Kato,Tomoyuki Murakami,Kenji Nakatsuma,Yasutaka Inuzuka,Ryuzo Sakata,Shinichi Shirai,Toshikazu Jinnai,Keiichiro Yamane,Yasuyo Takeuchi,Katsuhisa Ishii,Naritatsu Saito,Chiyo Maeda,Yoshiaki Kawase

doi:10.1038/s41598-017-15316-6

Abstract

Whether patients with severe aortic stenosis (AS) die because of AS-related causes is an important issue for the management of these patients. We used data from CURRENT AS registry, a Japanese multicenter registry, to assess the causes of death in severe AS patients and to identify the factors associated with non-cardiac mortality. We enrolled 3815 consecutive patients with a median follow-up of 1176 days; the 1449 overall deaths comprised 802 (55.3%) from cardiac and 647 (44.7%) from non-cardiac causes. Heart failure (HF) (25.7%) and sudden death (13.0%) caused the most cardiac deaths, whereas infection (13.0%) and malignancy (11.1%) were the main non-cardiac causes. According to treatment strategies, infection was the most common cause of non-cardiac death, followed by malignancy, in both the initial aortic valve replacement (AVR) cohort (N = 1197), and the conservative management cohort (N = 2618). Both non-cardiac factors (age, male, body mass index <22, diabetes, prior history of stroke, dialysis, anemia, and malignancy) and cardiac factors (atrial fibrillation, ejection fraction <68%, and the initial AVR strategy) were associated with non-cardiac death. These findings highlight the importance of close monitoring of non-cardiac comorbidities, as well as HF and sudden death, to improve the mortality rate of severe AS patients.

Highlights

Aortic stenosis (AS) is the most common valvular disease worldwide
The investigation of the causes of death can provide knowledge crucial to answer the question if the patients with AS die from AS-related causes or not, and how we should manage the patients in the era in which transcatheter aortic valve implantation (TAVI) is becoming widely used
Among the 3815 study patients, 1197 patients were managed with the initial aortic valve replacement (AVR) strategy, while 2618 patients were managed with the conservative strategy

Summary

Introduction

Aortic stenosis (AS) is the most common valvular disease worldwide. AS predominantly affects the elderly because age-related degenerative changes are the main etiologies. Non-cardiac deaths accounted for approximately half of the mortalities beyond 30 days after transcatheter aortic valve implantation (TAVI)[6]. Causes of death are often analyzed in selected cohorts, such as candidates for surgical aortic valve replacement, or in randomized controlled studies wherein the relatively strict enrollment criteria limit participation. High risk surgical candidates no longer undergo classical surgery, but receive TAVI, as do inoperable patients[8]. These patients are more likely to die because of non-cardiac causes. The investigation of the causes of death can provide knowledge crucial to answer the question if the patients with AS die from AS-related causes or not, and how we should manage the patients in the era in which TAVI is becoming widely used

Methods

Results

Conclusion