Abstract
BACKGROUND: Aortic stenosis (AS) is a prevalent heart valve disease; however, morbidity and mortality are significantly reduced by aortic valve replacement (AVR). The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used to assess perioperative mortality risk in patients with severe AS undergoing AVR. This study aimed to evaluate the prognostic value of EuroSCORE II for long-term all-cause mortality in Chinese patients with moderate-to-severe AS, determine whether AVR affects this prognostic value, and identify the best cut-off value for low-risk EuroSCORE II patients without AVR. METHODS: A total of 544 patients with moderate-to-severe AS were divided into four groups based on the associated EuroSCORE II value (cut-off of 4%) and whether the patient had previously undergone AVR. Kaplan-Meier survival analysis, Cox regression, and subgroup analyses were performed to assess the association between EuroSCORE II and all-cause mortality. A receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for predicting mortality. RESULTS: A total of 132 (24.3%) participants reached the endpoint during a median follow-up of 3.45 years. Patients with a EuroSCORE II ≥4% who did not undergo AVR had significantly higher all-cause mortality rates compared to other groups (55.4% vs. 6.5%, 32.7%, and 13.4%; p < 0.001). Kaplan-Meier analysis confirmed these findings (log-rank test, p < 0.001). Cox regression showed a 6.89-fold increased risk in patients without AVR and higher EuroSCORE II values (hazard ratio (HR), 6.891; 95% confidence interval (CI), 3.083-15.401; p < 0.001). The optimal cut-off value for predicting mortality in patients without AVR was 2.23% (area under the curve (AUC), 0.675). CONCLUSIONS: Both EuroSCORE II (cut-off value of 4%) and AVR status were independently associated with the long-term prognosis of patients with moderate-to-severe AS. CLINICAL TRIAL REGISTRATION: NCT06069232, https://clinicaltrials.gov/study/NCT06069232.