title: Comorbidity and intervention in octogenarians with severe symptomatic aortic stenosis.
abstract: BACKGROUND
  The benefit from intervention in elderly patients with symptomatic severe aortic stenosis (AS) and high comorbidity is unknown. Our aims were to establish the correlation between the Charlson comorbidity index and the prognosis of octogenarians with symptomatic sever AS and to identify patients who might not benefit from intervention.
  
  
  METHODS
  We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario--Prognosis of symptomatic severe aortic stenosis in octogenarians), a prospective registry that included consecutively 928 patients aged ≥ 80 years with severe symptomatic AS.
  
  
  RESULTS
  The mean Charlson comorbidity index was 3.0 ± 1.7, a total of 151 patients (16.3%) presented high comorbidity (index ≥ 5). Median survival was lower for patients with high comorbidity than for those without (16.7 ± 1.2 vs. 26.5 ± 0.6 months, p < 0.001). In patients without high comorbidity planned interventional management was clearly associated with prognosis (log rank p < 0.001), which was not the case in patients with high comorbidity (log rank p > 0.10). In multivariate analysis, the only variables that were independently associated with prognosis were planned medical management and Charlson index. Patients with high comorbidity presented non-cardiac death more frequently than those who had not (28.6% vs. 19.5%, p = 0.008).
  
  
  CONCLUSIONS
  One sixth of octogenarians with symptomatic severe AS have very high comorbidity (Charlson index ≥ 5). These patients have a poor prognosis in the short term and do not seem to benefit from interventional treatment.
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid y Universidad Europea de Madrid, Spain. Electronic address: mmselles@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Díez-Villanueva
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Sánchez-Sendin
authors.affiliation: Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Amelia
authors.initials: A
authors.lastname: Carro Hevia
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gómez Doblas
authors.affiliation: Servicio de Cardiología, Hospital de Manacor, Mallorca, Spain.
authors.forename: Bernardo
authors.initials: B
authors.lastname: García de la Villa
authors.affiliation: Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Cornide
authors.affiliation: Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Alonso Tello
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Andión Ogando
authors.affiliation: Servicio de Cardiología, Hospital Son Llatzer, Palma de Mallorca, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Ripoll Vera
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Salamanca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arribas Jiménez
authors.affiliation: Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrillo
authors.affiliation: Servicio de Geriatría, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez Pascual
authors.affiliation: Servicio de Cardiología, Hospital Plató, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Casares I Romeva
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Borras
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Vázquez
authors.affiliation: Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: López-Palop
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Aortic stenosis; Charlson; Elderly; Prognosis