Yasmin Farah, Shaikh Asim, Asghar Muhammad Sohaib, Moeed Abdul, Najeeb Hala, Waqar Eisha, Ram Muskaan Doulat, Nankani Avinash, Ochani Rohan Kumar, Aamir Muhammad, Ullah Waqas, Waqar Fahad, Johnson Drew M
Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Curr Probl Cardiol. 2023 Mar;48(3):101477. doi: 10.1016/j.cpcardiol.2022.101477. Epub 2022 Nov 1.
The merits of conservative management vs early intervention in patients with asymptomatic severe aortic stenosis remains unknown. Digital databases (MEDLINE, Google Scholar, and Embase) were searched for all relevant studies from inception through September 2022. Studies comparing conservative management with early intervention were compared using a random-effects model to calculate risk ratios (RRs) with 95% confidence interval (CI). A total of 12 studies comprising 3624 asymptomatic aortic stenosis patients (1747 receiving surgery, and 1877 receiving conservative treatment) were included in the analysis. The average follow-up time was 4.45 (IQR 3.5-5) years. Early intervention was associated with a significantly reduced risk of cardiac (RR 0.42, 95% CI 0.25-0.72; P = 0.001; I = 54%), non-cardiac (RR 0.46, 95% CI 0.32-0.68; P < 0.0001; I = 0%), all-cause mortality (RR 0.40, 95% CI 0.32-0.51; P < 0.00001; I = 58%), heart failure hospitalization (RR 0.21, 95% CI 0.13-0.36; P < 0.00001; I = 0%), sudden cardiac death (RR 0.29, 95% CI 0.12-0.66; P = 0.004, I = 24%), and MACE (RR 0.46, 95% CI; 0.28-0.75; P = 0.002; I = 68%), compared with conservative management. There was no significant difference in the 30-day mortality (RR 0.63, 95% CI 0.19-2.04; P = 0.44; I = 28%), myocardial infarction (RR 0.44, 95% CI 0.19-1.06; P = 0.07, I=0%), and 90-day mortality (RR 0.68, 95% CI 0.20-2.37; P = 0.55; I = 61%) between the 2 groups. This meta-analysis shows statistically significant reductions in the risk for all-cause mortality, cardiac specific mortality, non-cardiac mortality, heart failure hospitalization, MACE, and sudden cardiac death among asymptomatic aortic stenosis patients who underwent early intervention as opposed to conservative management.
对于无症状的重度主动脉瓣狭窄患者，保守治疗与早期干预的优缺点尚不清楚。检索数字数据库（MEDLINE、谷歌学术和Embase），查找从建库至2022年9月的所有相关研究。使用随机效应模型比较保守治疗与早期干预的研究，以计算风险比（RRs）及95%置信区间（CI）。分析共纳入12项研究，包括3624例无症状主动脉瓣狭窄患者（1747例接受手术，1877例接受保守治疗）。平均随访时间为4.45（四分位间距3.5 - 5）年。与保守治疗相比，早期干预可显著降低心脏相关风险（RR 0.42，95% CI 0.25 - 0.72；P = 0.001；I = 54%）、非心脏相关风险（RR 0.46，95% CI 0.32 - 0.68；P < 0.0001；I = 0%）、全因死亡率（RR 0.40，95% CI 0.32 - 0.51；P < 0.00001；I = 58%）、心力衰竭住院率（RR 0.21，95% CI 0.13 - 0.36；P < 0.00001；I = 0%）、心源性猝死率（RR 0.29，95% CI 0.12 - 0.66；P = 0.004，I = 24%）和主要不良心血管事件（RR 0.46，95% CI；0.28 - 0.75；P = 0.002；I = 68%）。两组在30天死亡率（RR 0.63，95% CI 0.19 - 2.04；P = 0.44；I = 28%）、心肌梗死（RR 0.44，95% CI 0.19 - 1.06；P = 0.07，I = 0%）和90天死亡率（RR 0.68，95% CI 0.20 - 2.37；P = 0.55；I = 61%）方面无显著差异。这项荟萃分析表明，与保守治疗相比，接受早期干预的无症状主动脉瓣狭窄患者在全因死亡率、心脏特异性死亡率、非心脏死亡率、心力衰竭住院率、主要不良心血管事件和心源性猝死风险方面有统计学显著降低。
