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

Area of Science:

• Cardiology
• Clinical Medicine
• Epidemiology

Background:

• Aortic stenosis (AS) and coronary artery disease (CAD) have a suggested close interaction.
• The risk of myocardial infarction (MI) in AS patients, especially outside of aortic valve replacement, is not well-documented.

Purpose of the Study:

• To evaluate the incidence, risk factors, and outcomes of MI in patients with varying degrees of AS severity.

Main Methods:

• Prospective enrollment of 2,830 outpatients with native valvular AS (peak aortic jet velocity [Vmax] ≥2.5 m/s) between 2016-2017.
• AS severity classified as mild (Vmax 2.5-2.9), moderate (Vmax 3-3.9), or severe (Vmax ≥4).
• MI defined by the fourth universal definition, excluding type 2 MI.

Main Results:

• At 5 years, the cumulative incidence of MI was 2.5% (n=72), with prior coronary events (PCE) and angina symptoms increasing risk.
• Female gender was associated with decreased MI risk, while AS severity did not correlate with MI risk.
• Incident MI was a strong predictor of subsequent mortality (HR: 2.00, P < 0.001), with 52.8% mortality during follow-up.

Conclusions:

• The risk of MI in AS patients is generally low, especially in those without prior coronary events or angina.
• No correlation was found between AS severity and MI risk.
• Despite its rarity, incident MI significantly elevates the risk of mortality in patients with aortic stenosis.