Survival and Management of Patients With Discordant High-Gradient Aortic Stenosis: A Propensity-Matched Study.

Introduction We aimed to compare concordant high gradient (HG) aortic stenosis (AS) (aortic valve area [AVA]  Background Despite the lack of evidences, European guidelines have suggested that discordant HG-AS should be considered as severe AS. Method We included 2701 patients (mean age 76 years) with HG-AS (2606 concordant and 95 discordant) and preserved ejection fraction (EF). Results After adjustment, patients with discordant HG-AS experienced lower 5-year survival than those with concordant HG-AS [HR (95%CI) = 1.59(1.04–2.56)]. The one and five-year cumulative incidence of aortic valve replacement (AVR) was lower for discordant HG-AS (61 ± 5% and 83 ± 4% versus 82 ± 1% and 90 ± 1% for concordant HG-AS, P  Fig. 1 ). Conclusion In clinical practice, patients with discordant HG-AS are less referred for AVR and later than those with concordant HG-AS resulting in excess mortality. Consequently, after exclusion of a reversible high flow status, discordant HG-AS should be considered as severe AS and managed as such. Concordant versus discordant high-gradient AS.