Aortic Valve Sclerosis Adds to Prediction of Short-Term Mortality in Patients with Documented Coronary Atherosclerosis

Journal of Clinical Medicine

Pompilio Faggiano¹  Paola Gripari²  Elena Tremoli²  Mauro Pepi²  Damiano Baldassarre²  Francesco Alamanni²  Mauro Amato²  Vincenza Valerio²  Simone Barbieri²  Alice Bonomi²  Paola Songia²  VeronikaA. Myasoedova²  Fabrizio Veglia²  Paolo Poggio²  Laura Cavallotti² 

[1] Cardiology Division, Spedali Civili and University of Brescia, 25122 Brescia, Italy;Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;

关键词: survival;    surgical myocardial revascularization;    EuroSCORE II;    aortic valve sclerosis;   

DOI  :  10.3390/jcm8081172

来源: DOAJ

【 摘 要 】

Aims: Aortic valve sclerosis (AVSc), a non-uniform thickening of leaflets with an unrestricted opening, is characterized by inflammation, lipoprotein deposition, and matrix degradation. In the general population, AVSc predicts long-term cardiovascular mortality (+50%) even after adjustment for vascular risk factors and clinical atherosclerosis. We have hypothesized that AVSc is a risk-multiplier able to predict even short-term mortality. To address this issue, we retrospectively analyzed 90-day mortality of all patients who underwent isolated coronary artery bypass grafting (CABG) at Centro Cardiologico Monzino over a ten-year period (2006−2016). Methods: We analyzed 2246 patients and 90-day all-cause mortality was 1.5% (31 deaths). We selected only patients deceased from cardiac causes (n = 29) and compared to alive patients (n = 2215). A cardiologist classified the aortic valve as no-AVSc (n = 1352) or AVSc (n = 892). Cox linear regression and integrated discrimination improvement (IDI) analyses were used to evaluate AVSc in predicting 90-day mortality. Results: AVSc 90-day survival (97.6%) was lower than in no-AVSc (99.4%; p < 0.0001) with a hazard ratio (HR) of 4.0 (95%CI: 1.78, 9.05; p < 0.0001). The HR for AVSc, adjusted for propensity score, was 2.7 (95%CI: 1.17, 6.23; p = 0.02) and IDI statistics confirmed that AVSc significantly adds (p < 0.001) to the identification of high-risk patients than EuroSCORE II alone. Conclusion: Our data supports the hypothesis that a risk stratification strategy based on AVSc, added to ESII, may allow better recognition of patients at high-risk of short-term mortality after isolated surgical myocardial revascularization. Results from this study warrant further confirmation.

【 授权许可】

Unknown