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Eri Minamino-Muta, Takao Kato, Takeshi Morimoto, Tomohiko Taniguchi, Kenji Nakatsuma, Yuki Kimura, Moriaki Inoko, Shinichi Shirai, Norio Kanamori, Koichiro Murata, Takeshi Kitai, Yuichi Kawase, Makoto Miyake, Chisato Izumi, Hirokazu Mitsuoka, Yutaka Hirano, Tomoki Sasa, Kazuya Nagao, Tsukasa Inada, Ryusuke Nishikawa, Yasuyo Takeuchi, Shintaro Yamagami, Keiichiro Yamane, Kanae Su, Akihiro Komasa, Katsuhisa Ishii, Yugo Yamashita, Yoshihiro Kato, Kensuke Takabayashi, Naritatsu Saito, Kenji Minatoya, Takeshi Kimura, CURRENT AS registry Investigators, Malignant disease as a comorbidity in patients with severe aortic stenosis: clinical presentation, outcomes, and management, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 4, Issue 3, July 2018, Pages 180–188, https://doi.org/10.1093/ehjqcco/qcy010
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Abstract
To investigate the effect of malignancy on the outcomes of patients with severe aortic stenosis (AS) and the management strategy for AS with malignancy.
Using data of 3815 patients with severe AS in a retrospective multicentre registry [CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry], we compared 3-year clinical outcomes among three groups based on malignancy status: with malignancy currently under treatment including best supportive care (malignancy group), with a history of malignancy without any current treatment (past history group), or without history of malignancy (no malignancy group). Patients in the malignancy group (n = 124) were more often men and had higher prevalence of low body mass index, recurrence of malignancy, anaemia, and asymptomatic status, despite comparable surgical risks and echocardiographic parameters. The malignancy group or the past history group (n = 389) had significantly higher risk for all-cause death [hazard ratio (HR) 2.49, 95% CI (95% confidence interval) 1.98–3.14; HR 1.23, 95% CI 1.04–1.46] and for malignancy-related death (HR 16.2, 95% CI 10.64–24.54; HR 3.66, 95% CI 2.43–5.52) than that of the no malignancy group (n = 3302). The excess risk for aortic valve-related death was not observed in the malignancy group (HR 0.79, 95% CI 0.48–1.29) and was lower in the past history group (HR 0.72, 95% CI 0.53–0.96). In the malignancy group, the treatment strategy (surgery: n = 16, conservative management: n = 108) was determined based on the clinical status of AS or life expectancy.
Malignancy had marked effect on all-cause death and malignancy-related death in patients with severe AS. History of malignancy also had a smaller but significant effect on mortality.
