Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis
Authors: Kanamori Norio , Taniguchi Tomohiko , Morimoto Takeshi , Shiomi Hiroki , Ando Kenji , Murata Koichiro , Kitai Takeshi , Kawase Yuichi , Izumi Chisato , Miyake Makoto , Mitsuoka Hirokazu , Kato Masashi , Hirano Yutaka , Matsuda Shintaro , Nagao Kazuya , Inada Tsukasa , Mabuchi Hiroshi , Takeuchi Yasuyo , Yamane Keiichiro , Toyofuku Mamoru , Ishii Mitsuru , Minamino-Muta Eri , Kato Takao , Inoko Moriaki , Ikeda Tomoyuki , Komasa Akihiro , Ishii Katsuhisa , Hotta Kozo , Higashitani Nobuya , Kato Yoshihiro , Inuzuka Yasutaka , Maeda Chiyo , Jinnai Toshikazu , Morikami Yuko , Saito Naritatsu , Minatoya Kenji , Aoyama Takeshi , Kimura Takeshi ,   CURRENT AS registry Investigators, Imai Masao , Tazaki Junichi , Toyota Toshiaki , Higami Hirooki , Kawaji Tetsuma , Shirai Shinichi , Kourai Kengo , Arita Takeshi , Miura Shiro , Yamaji Kyohei , Onodera Tomoya , Furukawa Yutaka , Kim Kitae , Kadota Kazushige , Iwasaki Keiichiro , Miyawaki Hiroshi , Misao Ayumi , Kuwayama Akimune , Ohya Masanobu , Shimada Takenobu , Amano Hidewo , Nakagawa Yoshihisa , Amano Masashi , Takahashi Yusuke , Yoshikawa Yusuke , Nishimura Shunsuke , Kuroda Maiko , Shirotani Manabu , Miki Shinji , Mizoguchi Tetsu , Yokomatsu Takafumi , Kushiyama Akihiro , Yaku Hidenori , Watanabe Toshimitsu , Miyazaki Shunichi , Takahashi Naoki , Fukuchi Kohei , Murakami Tomoyuki , Takeda Teruki , Sakaguchi Tomoko , Maeda Keiko , Yamaji Masayuki , Maenaka Motoyoshi , Tadano Yutaka , Sakamoto Hiroki , Motooka Makoto , Nishikawa Ryusuke , Eizawa Hiroshi , Kawato Mitsunori , Kinoshita Minako , Aida Kenji , Tamura Takashi , Takahashi Kousuke , Ko Euihong , Akao Masaharu , Masunaga Nobutoyo , Ogawa Hisashi , Iguchi Moritake , Unoki Takashi , Takabayashi Kensuke , Hamatani Yasuhiro , Yamashita Yugo , Himura Yoshihiro , Sato Yukihito , Tsuji Shuhei , Konishi Takashi , Sogabe Kouji , Tachiiri Michiya , Matsumura Yukiko , Ota Chihiro , Kouchi Ichiro , Ikeguchi Shigeru , Nishio Soji , Seki Jyunya , Shinoda Eiji , Yamada Miho , Kawamoto Akira , Kitaguchi Shoji , Sakata Ryuzo , Matsuda Mitsuo , Sugioka Sachiko , Hiraoka Yuji , Hanyu Michiya , Yamazaki Fumio , Koyama Tadaaki , Komiya Tatsuhiko , Yamanaka Kazuo , Nishiwaki Noboru , Nakajima Hiroyuki , Ohnaka Motoaki , Osada Hiroaki , Meshii Katsuaki , Saga Toshihiko , Onoe Masahiko , Nakayama Shogo , Sakaguchi Genichi , Iwakura Atsushi , Shiraga Kotaro , Ueyama Koji , Fujiwara Keiichi , Fukumoto Atsushi , Miwa Senri , Nishizawa Junichiro , Kitano Mitsuru 
Published: June 2018

It is unknown how much different are the clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis (AS). In the CURRENT AS registry enrolling 3,815 consecutive patients with severe AS, we compared the long-term outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea: N = 813, syncope: N = 136, and angina: N = 266) without heart failure (HF) hospitalization. Symptomatic patients had greater AS severity, and more depressed left ventricular function than asymptomatic patients without much difference in other baseline characteristics. During a median follow-up of 3.2 years, aortic valve replacement (AVR) was performed in 62% of symptomatic patients, and 38% of asymptomatic patients. The cumulative 5-year incidences for the primary outcome measure (a composite of aortic valve-related death or HF hospitalization) was higher in symptomatic patients than in asymptomatic patients (32.3% versus 27.6%, P < 0.001). After adjusting for AVR and other variables, the greater risk of symptomatic relative to asymptomatic patients for the primary outcome measure was significant (hazard ratio 1.64, 95% confidence interval 1.41–1.96, P < 0.001). In conclusions, the excess risk of symptomatic relative to asymptomatic patients with severe AS for the aortic valve-related event was significant. However, the prevalence of AVR in symptomatic patients was not optimal.