There were gaps between guidelines and practice when surgery was the only treatment
for aortic stenosis (AS).This study analyzed the decision to intervene in patients
with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart
Disease) II survey.Among 2,152 patients with severe AS, 1,271 patients with high-gradient
AS who were symptomatic fulfilled a Class I recommendation for intervention according
to the 2012 European Society of Cardiology guidelines; the primary end point was the
decision for intervention.A decision not to intervene was taken in 262 patients (20.6%).
In multivariate analysis, the decision not to intervene was associated with older
age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002),
New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI:
1.16 to 2.30; P = 0.005), higher age-adjusted Charlson comorbidity index (OR: 1.09
per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean
gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During
the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European
System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention
and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery.
A decision not to intervene versus intervention was associated with lower 6-month
survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001).A
decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS
despite a Class I recommendation for intervention and the decision was particularly
associated with older age and combined comorbidities. Transcatheter intervention was
extensively used in octogenarians.
