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

## TL;DR

This study finds that myocardial infarction is rare in aortic stenosis patients, with no link to AS severity, but is strongly linked to higher mortality.

## Contribution

The study provides new insights into MI risk and outcomes in aortic stenosis patients outside the context of valve replacement.

## Key findings

- The 5-year MI incidence in AS patients was only 2.5%, with no association to AS severity.
- Prior coronary events and angina were linked to higher MI risk, while female gender was protective.
- MI was rare but strongly associated with high mortality (52.8% during follow-up).

## Abstract

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.

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.

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).

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).

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.