Open AccessSudden Death in Patients With Severe Aortic Stenosis: Observations From the CURRENT AS Registry
Author(s) -
Taniguchi Tomohiko,
Morimoto Takeshi,
Shiomi Hiroki,
Ando Kenji,
Kanamori Norio,
Murata Koichiro,
Kitai Takeshi,
Kawase Yuichi,
Izumi Chisato,
Kato Takao,
Ishii Katsuhisa,
Nagao Kazuya,
Nakagawa Yoshihisa,
Toyofuku Mamoru,
Saito Naritatsu,
Minatoya Kenji,
Kimura Takeshi
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.008397
Subject(s) - medicine , asymptomatic , sudden death , hazard ratio , myocardial infarction , cardiology , aortic valve replacement , stenosis , incidence (geometry) , surgery , cumulative incidence , aortic valve stenosis , confidence interval , transplantation , physics , optics
Background The annual incidence of sudden death has been reported to be low (<1%/year) in asymptomatic patients with severe aortic stenosis ( AS ), and there is a paucity of data on the risk factors of sudden death in patients with severe AS . Methods and Results We evaluated the incidence and risk factors of sudden death during the median follow‐up period of 1334 days in the Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis (CURRENT AS) registry enrolling 3815 consecutive patients with severe AS between 2003 and 2011. The mean age was 78 years, and the prevalences of male sex and prior myocardial infarction were 38% and 8%, respectively. Sudden death occurred in 175 patients without aortic valve replacement. The cumulative 5‐year incidences of sudden death, censored at aortic valve replacement, which accounted for the competing risk, were 9.2% in symptomatic patients and 7.2% (1.4%/year) in asymptomatic patients ( P <0.001). Among 82 asymptomatic patients experiencing sudden death, 54 patients (66%) died abruptly without any preceding symptoms, and 35 (65%) of these sudden deaths occurred within 3 months of the last clinical follow‐up visit. Independent risk factors for sudden death were hemodialysis (hazard ratio [ HR ] 3.63; 95% confidence interval [ CI ] 2.42‐5.43), prior myocardial infarction ( HR 2.11; 95% CI 1.28‐3.50), body mass index <22 ( HR 1.51; 95% CI 1.03‐2.21), peak aortic jet velocity ≥5 m/s ( HR 1.76; 95% CI 1.12‐2.78), and left ventricular ejection fraction <60% ( HR 1.52; 95% CI 1.08‐2.14). Conclusions The incidence of sudden death in asymptomatic patients with severe AS might be higher than that reported in previous reports. Several baseline clinical and echocardiographic characteristics were associated with increased risk of sudden death. Clinical Trial Registration URL : www.umin.ac.jp/ctr/index.htm . Unique identifier: UMIN 000012140.