Thirty-day mortality after valve replacement for aortic stenosis over the last 22 years. A multivariate risk stratification

Over the last 22 years (1965–86), the 30-day mortality rate (30-DMR) after valve replacement for primary or predominant aortic stenosis (AS, N = 690) fell from 20.0% for the first 100 consecutive patients, via 7.8% for the next 490, to 2.0% for the final 100 (P < 00001). There was, however, a wide scatter in 30-DMR in the 11 consecutive 2-year periods, as well as during later years. The variation in 30-DMR was paralleled by changes in a high risk prognostic index (derived from a logistic regression model) and in a high coronary artery disease (CAD) score. In patients with a high CAD score who died within 30 days, 93% (N = 25) had CAD at autopsy compared with 37% (N = 11) of those with a low CAD score (P