Causes of death and mortality and evaluation of prognostic factors in patients with severe aortic stenosis in an aging society

Shiro Miura, Takeshi Arita, Hiraku Kumamaru, Takenori Domei, Kyohei Yamaji, Yoshimitsu Soga, Shinichi Shirai, Michiya Hanyu, Kenji Ando

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    23 Citations (Scopus)


    Background: Severe aortic stenosis (AS) is now predominantly a disease of the elderly, with significant mortality and morbidity. In order to investigate the burden of severe AS in the current population, we assessed mortality, causes of death, clinical event rates, and prognostic factors of patients diagnosed with severe AS. Methods: A total of 519 consecutive patients (mean age, 78±9 years) with severe AS (aortic valve area <1.0cm2) were retrospectively analyzed. All-cause mortality and clinical events including aortic valve replacement, heart failure requiring admission, acute coronary syndrome, and syncope were measured as main outcome. Results: During a median follow-up of 3.5 years, 167 patients (32%) died. Overall survival rates at 1 and 3 years were 86% and 70%, respectively. Of all deaths, 101 (61%) were cardiovascular-related and 56 (33%) were non-cardiovascular. Syncope occurred in only 18 (4%) patients, while heart failure requiring admission occurred in 188 (43%) patients as the most frequent event. Male, severe symptoms (New York Heart Association functional class, III/IV), inactive state, previous history of heart failure, renal insufficiency, hemodialysis treatment, peripheral vascular disease, malignancy, and statin use at enrollment were significantly and independently associated with death among the patients. Conclusions: Among the one-third of severe AS patients who died during follow-up, 61% of deaths were cardiovascular-related. Cardiovascular death may be the leading, but not the only, cause of death for contemporary severe AS patients. Factors such as severe symptomatic status, lower daily activity level, and chronic kidney diseases were strong predictive factors of worse survival in this population.

    Original languageEnglish
    Pages (from-to)353-359
    Number of pages7
    JournalJournal of Cardiology
    Issue number5
    Publication statusPublished - May 1 2015

    All Science Journal Classification (ASJC) codes

    • Cardiology and Cardiovascular Medicine


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