Meta-analysis of Early Intervention versus Conservative Management for Asymptomatic Severe Aortic Stenosis

Link to article at PubMed

Am J Cardiol. 2020 Oct 13:S0002-9149(20)31082-1. doi: 10.1016/j.amjcard.2020.10.013. Online ahead of print.

ABSTRACT

The main objective was to determine the optimal strategy for managing asymptomatic severe aortic stenosis (AS) between early intervention versus conservative management. We performed a systematic electronic search of the PubMed and Cochrane databases from the inception of the database to May 31st, 2020. The Mantel Haenszel method with the Paule-Mandel estimator of Tau2 and Hartung-Knapp adjustment were used to calculate relative risk (RR) with a 95% confidence interval (CI) and 95% prediction interval (PI). P curve analysis was used to assess publication bias and estimate the true effect of an intervention. All analysis was carried out using R version 3.6.2. A total of nine studies were included in the final analysis, consisting of 1775 patients with early intervention and 3040 patients with conservative management. Early intervention as compared with conservative management was associated with reduced risk of all-cause mortality (RR: 0.36, 95% CI: 0.24-0.53), cardiac mortality (RR: 0.36, 95% CI: 0.27-0.48) and non-cardiac mortality (RR: 0.40, 95% CI: 0.28-0.56). There was no difference in the risk of sudden cardiac death (RR: 0.46, 95% CI: 0.15-1.40), stroke (RR: 0.79, 95% CI: 0.17-3.64), myocardial infarction (RR: 0.44, 95% CI: 0.01-16.82) or heart failure hospitalization (RR: 0.18, 95% CI: 0.01-5.29) with early intervention compared with conservative management. In conclusion, early intervention is associated with reduced all-cause, cardiovascular, and non-cardiovascular mortality without increasing any procedure-related clinical outcomes among asymptomatic severe AS patients. Hence, this meta-analysis supports early intervention instead of watchful waiting for the management of asymptomatic severe AS. This systematic review and meta-analysis was registered with PROSPERO- CRD42020188439.

PMID:33065088 | DOI:10.1016/j.amjcard.2020.10.013

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