title: Does treatment assignment influence the prognosis of patients with symptomatic severe aortic stenosis?
abstract: OBJECTIVE
  Aortic valve replacement (AVR) is the standard therapy in patients with symptomatic aortic stenosis (AS). In high surgical risk patients, alternative therapeutic options to medical treatment (MT) such as trans-catheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) have been proposed. In this study we evaluated whether treatment assignment influences per se the prognosis of these subjects.
  
  
  METHODS
  Criteria for treatment assignment were based on patient's clinical conditions, Logistic EuroSCORE and other co-morbidities ignored by EuroSCORE. Due to baseline clinical differences between patients with diverse treatment assignment, we used propensity score matching to achieve balance.
  
  
  RESULTS
  368 patients were studied: 141 underwent AVR, 127 TAVI, 49 BAV and 51 MT. 84 events (deaths for all causes) occurred during 14 months of follow-up: 11 AVR (8%), 26 TAVI (20%), 18 MT (35%), 29 BAV group (59%). Traditional Cox analysis identified treatment assignment as independent predictor of events (HR 1.82 [CI 1.10-3.25]) together with lower left ventricular ejection fraction, impaired renal function and history of heart failure. Matched Cox analysis by propensity score confirmed treatment assignment as an independent prognosticator of events (HR 1.90 [CI 1.27-2.85]), and showed similar rate events in TAVI and AVR patients, while it was significantly increased in BAV and MT patients.
  
  
  CONCLUSIONS
  Treatment assignment may influence outcome of symptomatic patients with AS.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital Trento, Via Piave 78, 38100 Trento, Italy. gcioffi@villabiancatrento.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Cesare
authors.initials: C
authors.lastname: Tomasi
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Stefano
authors.initials: S
authors.lastname: Nistri
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faden
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D063126:Balloon Valvuloplasty; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome