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dc.contributor.authorTsampasian, Vasiliki
dc.contributor.authorGrafton-Clarke, Ciaran
dc.contributor.authorGracia Ramos, Abraham Edgar
dc.contributor.authorAsimakopoulos, George
dc.contributor.authorGarg, Pankaj
dc.contributor.authorPrasad, Sanjay
dc.contributor.authorRing, Liam
dc.contributor.authorMcCann, Gerry P
dc.contributor.authorRudd, James
dc.contributor.authorDweck, Marc R
dc.contributor.authorVassiliou, Vassilios S
dc.date.accessioned2022-06-29T19:42:19Z
dc.date.available2022-06-29T19:42:19Z
dc.date.issued2022-05
dc.identifier.issn2053-3624
dc.identifier.other35581008
dc.identifier.otherPMC9109115
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/338433
dc.descriptionFunder: National Institute for Health Research (NIHR)
dc.description.abstractOBJECTIVES: 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. METHODS: 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'. RESULTS: 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; I2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I2 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; I2 77%). CONCLUSION: 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. PROSPERO REGISTRATION NUMBER: CRD42022301037.
dc.languageeng
dc.publisherBMJ
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceessn: 2053-3624
dc.sourcenlmid: 101631219
dc.subjectMeta-analysis
dc.subjectAortic valve stenosis
dc.subjectAortic Diseases
dc.subjectAortic Valve
dc.subjectHumans
dc.subjectAortic Valve Stenosis
dc.subjectHeart Failure
dc.subjectTranscatheter Aortic Valve Replacement
dc.subjectConservative Treatment
dc.titleManagement of asymptomatic severe aortic stenosis: a systematic review and meta-analysis.
dc.typeArticle
dc.date.updated2022-06-29T19:42:19Z
prism.issueIdentifier1
prism.publicationNameOpen Heart
prism.volume9
dc.identifier.doi10.17863/CAM.85846
dcterms.dateAccepted2022-04-05
rioxxterms.versionofrecord10.1136/openhrt-2022-001982
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidTsampasian, Vasiliki [0000-0003-1534-7587]
dc.contributor.orcidGracia Ramos, Abraham Edgar [0000-0003-1842-2554]
dc.contributor.orcidMcCann, Gerry P [0000-0002-5542-8448]
dc.identifier.eissn2053-3624
pubs.funder-project-idEngineering and Physical Sciences Research Council (EP/N014588/1)
pubs.funder-project-idMedical Research Council (1966157)
pubs.funder-project-idEPSRC (EP/T017961/1)
cam.issuedOnline2022-05-17


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International