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A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis
  1. Ingar Holme1,
  2. Terje R Pedersen1,
  3. Kurt Boman2,
  4. Kenneth Egstrup3,
  5. Eva Gerdts4,
  6. Y Antero Kesäniemi5,6,7,
  7. William Malbecq8,
  8. Simon Ray9,
  9. Anne B Rossebø10,
  10. Kristian Wachtell11,
  11. Ronnie Willenheimer12,
  12. Christa Gohlke-Bärwolf13
  1. 1Department of Endocrinology, obesity and preventive medicine, Oslo University Hospital, Ulleval, Oslo, Norway
  2. 2Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Sweden
  3. 3Department of Medicine, Svendborg Hospital, Denmark
  4. 4Department of Heart Disease, Haukeland University Hospital, Bergen and Institute of Medicine, University of Bergen, Norway
  5. 5Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu, Finland
  6. 6Biocenter Oulo, University of Oulu, Finland
  7. 7Clinical Research Center, Oulu University Hospital, Oulu, Finland
  8. 8MSD Europe, Inc., Brussels, Belgium
  9. 9Department of Cardiology, University Hospitals of South Manchester, Manchester, UK
  10. 10Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
  11. 11Department of Cardiology B2142, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
  12. 12Lund University and Heart Health Group, Malmö, Sweden
  13. 13Herz-Zentrum Bad Krozingen, Germany
  1. Correspondence to Professor Ingar Holme, Department of Endocrinology, obesity and preventive medicine, Oslo University Hospital, Ulleval, Oslo, Norway; ingar.holme{at}nih.no

Abstract

Background Prognostic information for asymptomatic patients with aortic stenosis (AS) from prospective studies is scarce and there is no risk score available to assess mortality.

Objectives To develop an easily calculable score, from which clinicians could stratify patients into high and lower risk of mortality, using data from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.

Method A search for significant prognostic factors (p<0.01) among SEAS patients was made by a combined judgemental and statistical elimination procedure to derive a set of three factors (age, gender and smoking) that were forced into the model, and four additional factors captured by the data: left-ventricular mass index, bilirubin, heart rate and natural logarithm of C reactive protein. Calibration was done by comparing observed with calculated number of deaths by tenths of calculated risk using coefficients from the simvastatin + ezetimibe group on placebo group patients.

Results Discrimination was good with ROC area of 0.76 for all patients. Estimated probabilities of death were categorised into thirds. An optimised split point of estimated 5-year risk was about 15% (close to the upper 14% tertile split point), with risk 4 times as high in the upper compared to the two lower thirds. The SEAS score performed better than another established high risk score developed for other purposes.

Conclusion A new seven factor model for risk stratification of patients with mild to moderate asymptomatic AS identified a high risk group for total mortality with good discrimination properties.

Trial registration number ClinicalTrials.gov, NCT 00092677.

  • Simvastatin
  • ezetimibe
  • prognostic risk score
  • mortality
  • aortic valve stenosis
  • lipid trials
  • risk factors
  • statistics
  • echocardiography
  • hypertension
  • valvular disease
  • aortic valve disease
  • mitral regurgitation
  • constriction
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Footnotes

  • Funding EG, KB, ABR and YAK received research support from Merck/Schering-Plough Pharmaceuticals, Inc., North Wales, Pennsylvania, USA.

  • Competing interests IH, KB, KE, EG, CG-B, YAK, TRP, SR, ABR, KW and RW have received honoraria from Merck/Schering-Plough Pharmaceuticals, Inc., North Wales, Pennsylvania, USA, the funding sponsor of the SEAS study. IH, TRP and RW received honoraria from AstraZeneca, Inc., Wilmington, Delaware, USA and Pfizer Inc., New York, NY, USA. YAK received honoraria from Sanofi-Aventis, Paris, France, and AstraZeneca, Inc., Wilmington, Delaware, USA. WM is an employee of Merck/Schering-Plough Pharmaceuticals, Inc., and owns stock and/or stock options in the company.

  • Patient consent Obtained.

  • Ethics approval The study was approved by all regional ethics committees and all patients gave their written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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