P295Surprising secular increasing mortality of asymptomatic aortic stenosis

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Introduction: The guidelines that asymptomatic severe Aortic Stenosis (AS) has low mortality and therefore should be managed conservatively have recently been challenged. We assessed whether mortality has changed over the decades.Method: We analysed all published data on the follow up of patients with asymptomatic aortic stenosis from 1960 to 2010. We calculated five-year mortality figures for each study from the Kaplan-Meyer curves and produced weighted averages for each decade using the mid-recruitment point from each study for time-stratification.Results: 7 studies incorporating 1359 patients were identified. 5 year mortality was significantly correlated with decade (r2=0.91, p<0.01). Mid-recruitment point was not correlated with mean age (r2=0.417, p=0.12), average length of follow up (r2=0.06, p=0.15) or, if given, the presence of coronary disease (r2=0.04, p=0.67), LVH (r2=0.36, p=0.15) or ejection fraction (r2=0.04, p=0.67).Conclusion: The published mortality of patients with severe asymptomatic aortic stenosis managed conservatively has increased over the decades from the 1970's to the 2000's. This increase is not adequately explained by ageing of the population and is in contrast to decreases in other cardiovascular diseases.

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