title: Clinical outcome of asymptomatic severe aortic stenosis with medical and surgical management: importance of STS score at diagnosis.
abstract: BACKGROUND
  The Society of Thoracic Surgeons (STS) score aims at predicting operative mortality in cardiac surgery. The value of this score in predicting short- and long-term survival with medical or surgical management in patients with asymptomatic severe aortic stenosis (AS) is unknown.
  
  
  METHODS
  In a cohort of 694 patients (aged 71 ± 11 years) with isolated, asymptomatic severe AS (velocity ≥4 m/s), STS score was calculated at baseline and its link to survival analyzed. Patients were stratified by STS score less than 4%, 4% to 6.5%, and 6.5% or greater.
  
  
  RESULTS
  The STS score showed no association with operative mortality within 1 year of diagnosis or any time (1%, 2.9%, and 6.1%, respectively, by strata; p = 0.08) and a weak association with 1-year survival (p = 0.04). Conversely, long-term survival (10-year) was strongly predicted by STS score strata (78%, 47%, and 16%, respectively; p < 0.0001). In multivariate analysis, STS score independently predicted mortality (hazard ratio/1%, 1.15 [1.12 to 1.18], p < 0.0001) or cardiac death (1.21 [1.17 to 1.25], p < 0.0001). Aortic valve replacement within 1 year of diagnosis markedly improved survival (adjusted hazard ratio, 0.58, p < 0.001). However, benefit of early surgery varied according to strata, with no overt benefit with low score (p = 0.83), whereas early surgery considerably improved survival in the intermediate strata (p < 0.001).
  
  
  CONCLUSIONS
  For patients with asymptomatic severe AS, STS score is a powerful tool for predicting long-term outcome and for selecting patients (particularly those at intermediate risk) who benefit markedly from early surgery. Hence, risk-scoring using STS score should be routinely performed in patients with AS to support the clinical decision-making process.
authors.affiliation: Division of Cardiovascular Diseases and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Tourneau
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Morgan L
authors.initials: ML
authors.lastname: Brown
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Mahoney
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D001783:Blood Flow Velocity / Q000502:physiology; D002404:Catheterization / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology