Management of Nonagenarian Patients With Severe Aortic Stenosis: The Role of Comorbidity

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dc.contributor.author Bernal, Eva
dc.contributor.author Ariza Solé, Albert
dc.contributor.author Bayés Genís, Antoni
dc.contributor.author Formiga, Francesc
dc.contributor.author Díez-Villanueva, Pablo
dc.contributor.author Romaguera, Rafael
dc.contributor.author González Saldivar, Hugo
dc.contributor.author Martínez Sellés Oliveria Soares, Manuel
dc.date.accessioned 2017-12-11T22:56:22Z
dc.date.available 2017-12-11T22:56:22Z
dc.date.issued 2018
dc.identifier.citation Bernal, E., Ariza-Solé, A., Bayés-Genís, A., Formiga, F., Díez-Villanueva, P., Romaguera, R., ... & Martínez-Sellés, M. (2018). Management of Nonagenarian Patients With Severe Aortic Stenosis: The Role of Comorbidity. Heart, Lung and Circulation, 27(2), 219-226. spa
dc.identifier.issn 1443-9506
dc.identifier.issn 1444-2892
dc.identifier.uri http://hdl.handle.net/11268/6857
dc.description.abstract Background: The number of nonagenarian patients with aortic stenosis will likely increase due to the ageing population. We assessed the clinical characteristics, management, and outcomes of nonagenarian patients with severe aortic stenosis. Methods: A total of 177 (117 females and 60 males) consecutive nonagenarian patients from two large contemporary registries were included in this study. Clinical characteristics, comorbidity as assessed by the Charlson Index, clinical management, and outcomes were recorded. The main outcome measure was one-year mortality. Results: The mean patient age was 91.1 years, and 56 patients (31.6%) had a Charlson Index <3. A strong association between comorbidity and one-year overall mortality was observed, with higher one-year mortality in patients with Charlson Index ≥3 (66.4% vs. 32.1%, p < 0.001). A total of 150 patients (84.7%) were managed conservatively, and 27 (15.3%) underwent transcatheter aortic valve implantation (TAVI). Predictors of a conservative management were treatment out of TAVI centres, lower mean aortic gradient and better functional class. Clinical management was not significantly different with different degrees of comorbidity. A trend toward higher mortality in patients undergoing conservative management was observed (58% vs. 40.7%, p = 0.097). Independent predictors of mortality were higher Charlson Index, lower creatinine clearance, lower mean aortic gradient, poorer left ventricular ejection fraction, significant mitral regurgitation and conservative management. Conclusions: About one third of nonagenarians with severe aortic stenosis have few comorbidities. The clinical management was similar irrespective of the Charlson Index. Both higher Charlson Index values and a conservative management were independently associated with a higher mortality. spa
dc.description.sponsorship SIN FINANCIACIÓN spa
dc.language.iso eng spa
dc.title Management of Nonagenarian Patients With Severe Aortic Stenosis: The Role of Comorbidity spa
dc.type article spa
dc.description.impact 1.921 JCR (2017) Q3, 76/128 Cardiac and Cardiovascular Systems spa
dc.identifier.doi 10.1016/j.hlc.2017.02.033
dc.rights.accessRights closedAccess spa
dc.subject.uem Estenosis carotídea spa
dc.subject.uem Ancianos spa
dc.subject.unesco Enfermedad cardiovascular spa
dc.subject.unesco Tratamiento médico spa
dc.subject.unesco Anciano spa
dc.description.filiation UEM spa
dc.peerreviewed Si spa

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