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Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

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dc.contributor.author홍그루-
dc.date.accessioned2020-02-26T06:41:21Z-
dc.date.available2020-02-26T06:41:21Z-
dc.date.issued2020-
dc.identifier.issn0028-4793-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/175251-
dc.description.abstractBACKGROUND: The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. METHODS: In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm2 with either an aortic jet velocity of ≥4.5 m per second or a mean transaortic gradient of ≥50 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up. RESULTS: In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P = 0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years. CONCLUSIONS: Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care. (Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number, NCT01161732.).-
dc.description.statementOfResponsibilityrestriction-
dc.languageEnglish-
dc.publisherMassachusetts Medical Society-
dc.relation.isPartOfNEW ENGLAND JOURNAL OF MEDICINE-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.subject.MESHAged-
dc.subject.MESHAortic Valve/surgery*-
dc.subject.MESHAortic Valve Stenosis/mortality-
dc.subject.MESHAortic Valve Stenosis/surgery*-
dc.subject.MESHAortic Valve Stenosis/therapy-
dc.subject.MESHAsymptomatic Diseases/therapy-
dc.subject.MESHCardiovascular Diseases/mortality-
dc.subject.MESHConservative Treatment*-
dc.subject.MESHFemale-
dc.subject.MESHFollow-Up Studies-
dc.subject.MESHHumans-
dc.subject.MESHIncidence-
dc.subject.MESHKaplan-Meier Estimate-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHPatient Acuity-
dc.subject.MESHPostoperative Complications/mortality-
dc.titleEarly Surgery or Conservative Care for Asymptomatic Aortic Stenosis-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Internal Medicine (내과학교실)-
dc.contributor.googleauthorDuk-Hyun Kang-
dc.contributor.googleauthorSung-Ji Park-
dc.contributor.googleauthorSeung-Ah Lee-
dc.contributor.googleauthorSahmin Lee-
dc.contributor.googleauthorDae-Hee Kim-
dc.contributor.googleauthorHyung-Kwan Kim-
dc.contributor.googleauthorSung-Cheol Yun-
dc.contributor.googleauthorGeu-Ru Hong-
dc.contributor.googleauthorJong-Min Song-
dc.contributor.googleauthorCheol-Hyun Chung-
dc.contributor.googleauthorJae-Kwan Song-
dc.contributor.googleauthorJae-Won Lee-
dc.contributor.googleauthorSeung-Woo Park-
dc.identifier.doi10.1056/NEJMoa1912846-
dc.contributor.localIdA04386-
dc.relation.journalcodeJ02371-
dc.identifier.eissn1533-4406-
dc.identifier.pmid31733181-
dc.identifier.urlhttps://www.nejm.org/doi/full/10.1056/NEJMoa1912846-
dc.contributor.alternativeNameHong, Geu Ru-
dc.contributor.affiliatedAuthor홍그루-
dc.citation.volume382-
dc.citation.number2-
dc.citation.startPage111-
dc.citation.endPage119-
dc.identifier.bibliographicCitationNEW ENGLAND JOURNAL OF MEDICINE, Vol.382(2) : 111-119, 2020-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

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