Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement.

Background and objectives: Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis. Methods: From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR. Results: After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78 +/- 7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73 +/- 0.20 cm(2) and mean left ventricular ejection fraction (LVEF) was 57.8 +/- 12.2%. Total 102 patients died during follow-tip period (39.1 +/- 31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1 +/- 3.0%, 43.1 +/- 3.8%, and 56.5 +/- 4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0 +/- 2.9%, 38.2 +/- 3.8%, and 50.7 +/- 4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p<0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p<0.001, p<0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality. Conclusions: In elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1 +/- 3.0%, 43.1 +/- 3.8%, and 56.5 +/- 4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.