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.
Aortic valve sclerosis adds to prediction of short-term mortality in patients with documented coronary atherosclerosis / P. Poggio, L. Cavallotti, V.A. Myasoedova, A. Bonomi, P. Songia, P. Gripari, V. Valerio, M. Amato, S. Barbieri, P. Faggiano, F. Alamanni, F. Veglia, M. Pepi, E. Tremoli, D. Baldassarre. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 8:8(2019 Aug 05), pp. 1172.1-1172.8.
|Titolo:||Aortic valve sclerosis adds to prediction of short-term mortality in patients with documented coronary atherosclerosis|
POGGIO, PAOLO (Corresponding)
BALDASSARRE, DAMIANO (Ultimo) [Writing – Original Draft Preparation]
|Parole Chiave:||EuroSCORE II; aortic valve sclerosis; surgical myocardial revascularization; survival|
|Settore Scientifico Disciplinare:||Settore BIO/14 - Farmacologia|
|Data di pubblicazione:||5-ago-2019|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.3390/jcm8081172|
|Appare nelle tipologie:||01 - Articolo su periodico|