Clinical outcome of asymptomatic severe aortic stenosis with medical and surgical management: Importance of STS score at diagnosis

Thierry Le Tourneau, Patricia A. Pellikka, Morgan L. Brown, Joseph F. Malouf, Douglas W. Mahoney, Hartzell V. Schaff, Maurice Enriquez-Sarano

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Background The Society of Thoracic Surgeons (STS) score aims at predicting operative mortality in cardiac surgery. The value of this score in predicting short- and long-term survival with medical or surgical management in patients with asymptomatic severe aortic stenosis (AS) is unknown. Methods In a cohort of 694 patients (aged 71 ± 11 years) with isolated, asymptomatic severe AS (velocity <4 m/s), STS score was calculated at baseline and its link to survival analyzed. Patients were stratified by STS score less than 4%, 4% to 6.5%, and 6.5% or greater. Results The STS score showed no association with operative mortality within 1 year of diagnosis or any time (1%, 2.9%, and 6.1%, respectively, by strata; p = 0.08) and a weak association with 1-year survival (p = 0.04). Conversely, long-term survival (10-year) was strongly predicted by STS score strata (78%, 47%, and 16%, respectively; p < 0.0001). In multivariate analysis, STS score independently predicted mortality (hazard ratio/1%, 1.15 [1.12 to 1.18], p < 0.0001) or cardiac death (1.21 [1.17 to 1.25], p < 0.0001). Aortic valve replacement within 1 year of diagnosis markedly improved survival (adjusted hazard ratio, 0.58, p < 0.001). However, benefit of early surgery varied according to strata, with no overt benefit with low score (p = 0.83), whereas early surgery considerably improved survival in the intermediate strata (p < 0.001). Conclusions For patients with asymptomatic severe AS, STS score is a powerful tool for predicting long-term outcome and for selecting patients (particularly those at intermediate risk) who benefit markedly from early surgery. Hence, risk-scoring using STS score should be routinely performed in patients with AS to support the clinical decision-making process.

Original languageEnglish (US)
Pages (from-to)1876-1883
Number of pages8
JournalAnnals of Thoracic Surgery
Volume90
Issue number6
DOIs
StatePublished - Dec 1 2010

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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