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Publications

Journal Article Ppublish

PubMed: 40286367 DOI: 10.1016/j.jacadv.2025.101707

Risk of Myocardial Infarction in Patients With Aortic Stenosis: Insights From the VALVENOR Registry.

JACC Adv 4(5):101707

Authors: Gilles Lemesle, Augustin Coisne, Sandro Ninni, Samy Aghezzaf, Basile Verdier, Guillaume Schurtz, Arnaud Sudre, Thomas Modine, Amine Tazibet, Bart Staels, David Montaigne, Christophe Bauters

Affiliations

  • Heart and Lung Institute, University Hospital of Lille, CHU Lille, Lille, France; University of Lille, Lille, France; Institut Pasteur of Lille, Inserm U1011-EGID, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France.
  • University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
  • University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France.
  • Heart and Lung Institute, University Hospital of Lille, CHU Lille, Lille, France.
  • Department of Cardiac Surgery, CHU Bordeaux, Hôpital Cardiologique Haut Leveque, Pessac, France.

Abstract

BACKGROUND

A close interaction between aortic stenosis (AS) and coronary artery disease has been suggested. However, the risk of myocardial infarction (MI) in patients with AS is poorly described outside the context of aortic valve replacement.

OBJECTIVES

The purpose of this study was to assess the incidence, correlates, and impact on outcomes of MI occurrence in patients with different degrees of AS severity.

METHODS

Between 2016 and 2017, the multicenter prospective VALVENOR registry enrolled 2,830 outpatients with native valvular AS (peak aortic jet velocity [Vmax] ≥2.5 m/s). AS was defined as mild (Vmax 2.5-2.9), moderate (Vmax 3-3.9), or severe (Vmax ≥4). MI was defined using the fourth universal definition (type 2 MI were not considered).

RESULTS

The mean age was 76.0 years, 54% of the patients were men, and 18.3% had experienced prior coronary event (PCE). At 5 years, the cumulative incidence of MI (death as competing event) was only 2.5% (n = 72, one-third of ST-segment elevation MI). PCE and angina symptoms were associated with an increased risk, whereas female gender was associated with a decreased risk. By contrast, AS severity was not associated with the risk of MI. Subsequent mortality was high and at 52.8% during follow-up (median 648 days after MI occurrence). Incident MI was a powerful predictor of mortality (HR: 2.00, P < 0.001 after adjustment).

CONCLUSIONS

In patients with AS, the risk of MI is relatively low especially in patients without PCE and without angina. No association between the risk of MI and AS severity was observed. Although rare, incident MI is strongly associated with subsequent mortality.

MeSH

Registries, Constriction, Pathologic, Mortality, Aortic Valve Stenosis, Coronary Artery Disease, Myocardial Infarction, Incidence