Abstract
Background
Aortic stenosis (AS) and acute coronary syndrome (ACS) share similar cardiovascular
risk factors. The incidence of concomitant AS and ACS is increasing with aging population,
yet studies investigating the prognosis of these patients remain scarce.
Methods
This retrospective single-centre cohort study examined consecutive patients who presented
with ACS and AS from January 1, 2011, to March 31, 2021. The cohort was divided into
mild, moderate, and severe AS based on the index echocardiogram. The primary outcome
was all-cause mortality.
Results
Of 563 patients, 264 (46.9%) had mild, 193 (34.3%) moderate, and 106 (18.8%) severe
AS. The mean follow-up duration was 2.5 years. All-cause mortality was higher among
patients with moderate and severe AS compared with mild AS within 30 days (17.0% vs
13.0% vs 6.4%, respectively; P = 0.005) and in the long term (49.7% vs 51.4% vs 35.6%; P = 0.002). Concomitant moderate (hazard ratio [HR] 1.453, 95% confidence interval
[CI] 1.020-2.068; P = 0.038) or severe AS (HR 1.873, 95% CI 1.176-2.982; P = 0.008) was an independent predictor of all-cause mortality. Kaplan-Meier curves
demonstrated higher mortality in patients with moderate and severe AS compared with
mild AS (P < 0.001). Similar survival trends were observed regardless of ACS type and in those
with preserved left ventricular ejection fraction. Patients with reduced left ventricular
ejection fraction had poor prognosis regardless of AS severity.
Conclusions
ACS patients with concomitant moderate or severe AS have similar high long-term mortality,
regardless of ACS type. The high early mortality in moderate and severe AS emphasises
the imperative to attempt to mitigate this risk urgently.
Résumé
Contexte
La sténose aortique (SA) et le syndrome coronarien aigu (SCA) ont des facteurs de
risque cardiovasculaire similaires. L’incidence de SA et de SCA concomitants augmente
parallèlement au vieillissement de la population, mais on trouve peu d’études sur
le pronostic des patients atteints de ces cardiopathies.
Méthodologie
Cette étude de cohorte monocentrique rétrospective porte sur des patients consécutifs
ayant présenté un SCA et une SA entre le 1er janvier 2011 et le 31 mars 2021. La cohorte a été divisée en trois groupes de cas
correspondant à la gravité de la SA, soit légère, modérée ou sévère, en fonction de
l’échocardiogramme initial. Le paramètre d’évaluation principal était la mortalité
toutes causes confondues.
Résultats
Parmi les 563 patients recensés, 264 (46,9 %) présentaient une SA légère, 193 (34,3
%), une SA modérée et 106 (18,8 %), une SA sévère. La durée moyenne du suivi était
de 2,5 ans. La mortalité toutes causes confondues était plus élevée chez les patients
présentant une SA modérée ou sévère que chez les patients présentant une SA légère,
sur 30 jours (17,0 % vs 13,0 % vs 6,4 %, respectivement; P = 0,005) et à long terme (49,7 % vs 51,4 % vs 35,6 %; P = 0,002). La SA concomitante modérée (rapport des risques instantanés [RRI] : 1,453;
intervalle de confiance [IC] à 95 % : 1,020-2,068; P = 0,038) ou sévère (RRI : 1,873, IC à 95 % : 1,176-2,982; P = 0,008) constituait un facteur prédictif indépendant de mortalité toutes causes
confondues. Les courbes de Kaplan-Meier ont révélé que la mortalité était plus élevée
chez les patients présentant une SA modérée ou sévère que chez les patients présentant
une SA légère (P < 0,001). Des tendances de survie similaires ont été observées indépendamment du
type de SCA et chez les patients présentant une fraction d’éjection ventriculaire
gauche préservée. Le pronostic était sombre chez les patients présentant une fraction
d’éjection ventriculaire gauche réduite, indépendamment de la gravité de la SA.
Conclusions
Chez les patients présentant un SCA et une SA modérée ou sévère concomitante, la mortalité
à long terme est comparablement élevée, indépendamment du type de SCA. La mortalité
précoce élevée dans les cas de SA modérée ou sévère fait ressortir l’urgence d’agir
en vue d’en limiter le risque.
Graphical abstract
Graphical Abstract
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Article Info
Publication History
Published online: March 18, 2022
Accepted:
March 10,
2022
Received:
January 18,
2022
Footnotes
See editorial by Thompson, pages 1130–1131 of this issue.
See page 1226 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Acute Coronary Syndrome and Aortic Stenosis: A Lethal Combo!Canadian Journal of CardiologyVol. 38Issue 8
- PreviewIn this issue of the Canadian Journal of Cardiology, Chew and colleagues1 report on the outcomes of 563 patients with acute coronary syndrome (ACS) and aortic stenosis (AS), seen over a 10-year period. They demonstrate that approximately one-half of those with moderate or severe AS, and more than one-third of those with mild AS, died during follow-up, which averaged 2.5 years. Although these numbers are sobering, so too is the 30-day mortality of 17% for severe, 13% for moderate, and 6.4% for mild AS.
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