Early Intervention Versus Conservative Management for Asymptomatic Severe Aortic Stenosis: An Updated Meta-Analysis of Randomized Controlled Trials

The timely management of asymptomatic severe aortic stenosis (AS) presents an important clinical dilemma. This meta-analysis aims to investigate whether early intervention can lead to improved clinical outcomes compared with conservative management in asymptomatic severe AS. We conducted a literature search of major databases to identify randomized controlled trials that compared an early intervention (either early surgical aortic valve replacement or early transcatheter aortic valve replacement) with conservative management in patients with asymptomatic severe AS. Data for clinical outcomes were extracted, and risk ratios (RRs) were calculated for all end points with corresponding 95% confidence intervals (CIs). The meta-analysis included 4 randomized controlled trials with 1427 patients. Compared with conservative management, early intervention was associated with no significant difference in all-cause [RR, 0.52 (95% CI, 0.23-1.19)] or cardiovascular death [RR, 0.41 (95% CI, 0.10-1.64)]. A statistically significant reduction was observed in the risk of stroke [RR, 0.60 (95% CI, 0.38-0.94)] and unplanned hospitalizations [RR, 0.49 (95% CI, 0.40-0.60)] with an early intervention. The risk of myocardial infarction remained comparable [RR, 0.67 (95% CI, 0.13-3.54)]. Early intervention can be a suitable treatment option for patients with asymptomatic severe AS who prefer proactive management of their condition.