Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis
- Authors
- Kang, DH[Kang, Duk-Hyun]; Park, SJ[Park, Sung-Ji]; Lee, SA[Lee, Seung-Ah]; Lee, S[Lee, Sahmin]; Kim, DH[Kim, Dae-Hee]; Kim, HK[Kim, Hyung-Kwan]; Yun, SC[Yun, Sung-Cheol]; Hong, GR[Hong, Geu-Ru]; Song, JM[Song, Jong-Min]; Chung, CH[Chung, Cheol-Hyun]; Song, JK[Song, Jae-Kwan]; Lee, JW[Lee, Jae-Won]; Park, SW[Park, Seung-Woo]
- Issue Date
- 9-Jan-2020
- Publisher
- MASSACHUSETTS MEDICAL SOC
- Citation
- NEW ENGLAND JOURNAL OF MEDICINE, v.382, no.2, pp.111 - 119
- Indexed
- SCIE
SCOPUS
- Journal Title
- NEW ENGLAND JOURNAL OF MEDICINE
- Volume
- 382
- Number
- 2
- Start Page
- 111
- End Page
- 119
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/5951
- DOI
- 10.1056/NEJMoa1912846
- ISSN
- 0028-4793
- Abstract
- Background The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. Methods In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of <= 0.75 cm(2) with either an aortic jet velocity of >= 4.5 m per second or a mean transaortic gradient of >= 50 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up. Results In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P=0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years. Conclusions Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care. (Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number, NCT01161732.)
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Collections - Medicine > Department of Medicine > 1. Journal Articles
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