Management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis.
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Authors
Grafton-Clarke, Ciaran
Asimakopoulos, George
Garg, Pankaj
Prasad, Sanjay
Ring, Liam
Rudd, James
Dweck, Marc R
Vassiliou, Vassilios S
Publication Date
2022-05-01Journal Title
Open heart
ISSN
2053-3624
Volume
9
Issue
1
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Tsampasian, V., Grafton-Clarke, C., Gracia Ramos, A. E., Asimakopoulos, G., Garg, P., Prasad, S., Ring, L., et al. (2022). Management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis.. Open heart, 9 (1) https://doi.org/10.1136/openhrt-2022-001982
Description
Funder: National Institute for Health Research (NIHR)
Abstract
<h4>Objectives</h4>The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies.<h4>Methods</h4>PubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were 'asymptomatic', 'severe aortic stenosis' and 'intervention'.<h4>Results</h4>Meta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I<sup>2</sup> 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I<sup>2</sup> 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I<sup>2</sup> 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I<sup>2</sup> 77%).<h4>Conclusion</h4>This meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention.<h4>Prospero registration number</h4>CRD42022301037.
Keywords
Meta-analysis, Aortic valve stenosis, Aortic Diseases, Aortic Valve, Humans, Aortic Valve Stenosis, Heart Failure, Transcatheter Aortic Valve Replacement, Conservative Treatment
Sponsorship
Wellcome Trust (220703/Z/20/Z)
British Heart Foundation (FS/14/78/31020)
Identifiers
35581008, PMC9109115
External DOI: https://doi.org/10.1136/openhrt-2022-001982
This record's URL: https://www.repository.cam.ac.uk/handle/1810/338433
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