Valvular & structural heart diseaseResearch article
Clinical outcomes and impact of aortic valve replacement in concordant vs discordant high-gradient aortic stenosis
- Propensity score matching (PSM) (1:1) analysis of patients with high-gradient aortic stenosis
- Kaplan-Meier curves and Cox proportional hazards models
- competing-risk methods with death as a competing event
- Aortic valve replacement (AVR) as a time-dependent covariate
Authors' conclusion
After accounting for AVR, survival did not differ significantly between DHG-AS and CHG-AS. AVR was associated with improved survival in DHG-AS, supporting timely intervention.
Study context
- Population
- Patients with high-gradient aortic stenosis (mean gradient ≥ 40 mm Hg), categorized as concordant or discordant by AVAipatients included, after PSM, 958 patients were in each group · concordant high-gradient aortic stenosis (CHG-AS) 13,678 · discordant high-gradient aortic stenosis (DHG-AS) 962
- Participants
- 14,640 patients
- Comparison
- concordant high-gradient aortic stenosis and DHG-AS
- CHG-ASn = 13,678reference
- DHG-ASn = 962
Main finding
AVR rates
Subdistribution hazard ratio
0.56
95% CI 0.50–0.63
Gray P < .001
DHG-AS vs CHG-AS
SHR 0.56 (95% CI 0.50–0.63); Gray P < .001
As reported in the abstract
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Mortality · Ten-year — DHG-AS vs CHG-AS · univariable analysis; higher in DHG-AS | 1.24 (1.07–1.44) | P = 0.005 | |
| Mortality · Ten-year — DHG-AS vs CHG-AS · after adjusting for AVR | 1.07 (0.92–1.25) | ||
| Mortality with AVR in DHG-AS patients after PSM (subgroup) · 10-year · AVR reduced 10-year mortality; n = 360 per group · AVR as a time-dependent covariate | 0.538 (0.418–0.692) | ||
| 0.512Hazard ratio (log scale) |
Original publication
Clinical outcomes and impact of aortic valve replacement in concordant vs discordant high-gradient aortic stenosis. Am Heart J. Published 6 June 2026. doi:10.1016/j.ahj.2026.107507
Summarised from the published abstract; every number is checked against it