Valvular & structural heart diseaseMeta-analysis
Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe Aortic Stenosis
- Systematic review and meta-analysis of randomised trials
- study-level
- random-effects
Authors' conclusion
In this meta-analysis of 4 RCTs, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization and stroke and no differences in all-cause and cardiovascular mortality compared with CS.
Study context
- Population
- Asymptomatic severe aortic stenosis (AS)
- Participants
- 1,427 participants · 4 randomized controlled trials (RCTs)
- Comparison
- Early aortic valve replacement (AVR) vs clinical surveillance
- Early AVRn = 719
- Clinical surveillance (CS)n = 708reference
Pooled result
As reported in the abstract
Prespecified outcomes: unplanned CV or heart failure (HF) hospitalization, stroke, all-cause and CV mortality · average follow-up 4.1 years
Early AVR vs CSHazard ratio (95% CI)P value
unplanned CV or HF hospitalization; pooled rate 14.6% vs 31.9%; I2 = 4%
0.40(0.30–0.53)
P < 0.01stroke; pooled rate 4.5% vs 7.2%; I2 = 0%
0.62(0.40–0.97)
P = 0.03all-cause mortality; pooled rate 9.7% vs 13.7%; I2 = 61%
0.68(0.40–1.17)
P = 0.17CV mortality; pooled rate 5.1% vs 8.3%; I2 = 50%
0.67(0.35–1.29)
P = 0.23Original publication
Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe Aortic Stenosis. J Am Coll Cardiol. Published 18 November 2024. doi:10.1016/j.jacc.2024.11.006
Summarised from the published abstract; every number is checked against it