

Aortic Valve Stenosis and Acute Coronary Syndrome. Obvious Answers to Non-Obvious Questions
https://doi.org/10.18087/cardio.2025.5.n2886
Abstract
The article presents a systematic review focused on clinical features of acute coronary syndrome (ACS) and approaches to its diagnosis in patients with aortic stenosis (AS), as well as approaches to managing the risks of adverse events. The review includes publications from 2000 to 2024. The information in the review by 80% reflects the reports for the recent 5 years. The main databases used in searching for information and writing the review were eLibrary.ru, PubMed, platforms of Nature publishing houses, Springer materials, and PLOS (Public Library of Science). The following keywords were used for the search of publications: aortic stenosis, myocardial infarction, acute coronary syndrome. A total of 105 full-text publications were found; 64 publications best matching the topic of the review were used. The article presents up-to-date data on the complexities of differential diagnosis of decompensated AS and ACS, the general pathogenesis of coronary atherocalcinosis and AS, and promising algorithms for surgical treatment of patients with a combination of AS and various forms of ischemic heart disease (acute and chronic).
Keywords
About the Authors
O. L. BarbarashRussian Federation
Professor, Doctor of Medical Sciences, General Director
V. V. kashtalap
Russian Federation
Professor of the Department, Doctor of Medical Sciences
References
1. Barbarash O.L., Lyapina I.N. Current trends in organizing the care for patients with acquired heart valve disease. Russian Cardiology Bulletin. 2024;19(4):5–12. DOI: 10.17116/Cardiobulletin2024190415
2. Moreno R, ACP Journal Club Editorial Team at McMaster University. In asymptomatic severe AS, early surgery vs. conservative therapy reduced a composite of death, MI, stroke, or HF hospitalization at 63 mo. Annals of Internal Medicine. 2025;178(1):JC6. DOI: 10.7326/ANNALS-24-03367-JC
3. Takeji Y, Tada H, Taniguchi T, Sakata K, Kitai T, Shirai S et al. Current Management and Therapy of Severe Aortic Stenosis and Future Perspective. Journal of Atherosclerosis and Thrombosis. 2024;31(10):1353–64. DOI: 10.5551/jat.RV22023
4. Aluru JS, Barsouk A, Saginala K, Rawla P, Barsouk A. Valvular Heart Disease Epidemiology. Medical Sciences. 2022;10(2):32. DOI: 10.3390/medsci10020032
5. Medkov V.M. Demography. - Rostov-on-Don: Pheniks; 2002. - 448p. ISBN 5-222-01106-8
6. Messika-Zeitoun D, Baumgartner H, Burwash IG, Vahanian A, Bax J, Pibarot P et al. Unmet needs in valvular heart disease. European Heart Journal. 2023;44(21):1862–73. DOI: 10.1093/eurheartj/ehad121
7. Tolpygina S.N., Zagrebelny A.V., Martsevich S.Yu. Prognostic value of calcific aortic stenosis in patients of the PROGNOZ IBS registry. Russian Journal of Cardiology. 2022;27(1):42–7. DOI: 10.15829/1560-4071-2022-4836
8. Marangou J, Beaton A, Aliku TO, Nunes MCP, Kangaharan N, Reményi B. Echocardiography in Indigenous Populations and Resource Poor Settings. Heart, Lung and Circulation. 2019;28(9):1427–35. DOI: 10.1016/j.hlc.2019.05.176
9. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology. 2021;77(4):e25–197. DOI: 10.1016/j.jacc.2020.11.018
10. Dren’ E.V., Lyapina I.N., Pecherina T.B., Barbarash O.L. Phenotype of a modern patient with valvular heart diseases: literature review. CardioSomatics. 2023;14(4):269–82. DOI: 10.17816/CS601825
11. Sizov A.V., Zotov D.D. Myocardial infarction of the second type with severe aortic stenosis. University Therapeutic Journal. 2022;4(1):32–6. DOI: 10.56871/5991.2022.32.45.004
12. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. European Heart Journal. 2003;24(13):1231–43. DOI: 10.1016/ S0195-668X(03)00201-X
13. Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O et al. Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation. 2019;140(14):1156–69. DOI: 10.1161/CIRCULATIONAHA.119.041080
14. Karpova N.Yu., Rashid M.A., Chipigina N.S., Kazakova T.V., Zudilina A.E. Calcific aortic stenosis: known facts and promising studies. The Clinician. 2020;14(1–2):34–41. DOI: 10.17650/1818-8338-2020-14-1-2-34-41
15. Banovic M, Athithan L, McCann GP. Aortic stenosis and diabetes mellitus: An ominous combination. Diabetes and Vascular Disease Research. 2019;16(4):310–23. DOI: 10.1177/1479164118820657
16. Santangelo G, Bursi F, Faggiano A, Moscardelli S, Simeoli P, Guazzi M et al. The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management. Journal of Clinical Medicine. 2023;12(6):2178. DOI: 10.3390/jcm12062178
17. Cubrilo M, Banovic M, Matkovic M, Bilbija I, Aleksic N, Ivanisevic D et al. Incidence and Prognostic Significance of Silent Coronary Disease in Asymptomatic Patients with Severe Aortic Stenosis. Medicina. 2024;60(9):1503. DOI: 10.3390/medicina60091503
18. Andell P, Li X, Martinsson A, Andersson C, Stagmo M, Zöller B et al. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart. 2017;103(21):1696–703. DOI: 10.1136/heartjnl-2016-310894
19. Kearney K, Sigursdsson S, Eiriksdottir G, O’Brien KD, Gudnason V, Owens DS. Abstract 17756: incidence and progression of aortic valve calcification among the elderly: a prospective analysis of the age, geneenvironment susceptibility (AGES)-Reykjavik study. Circulation. 2012;126(Suppl 21):A17756. [Av. at: https://www.ahajournals.org/doi/abs/10.1161/circ.126.suppl_21.a17756]
20. Patel KP, Michail M, Treibel TA, Rathod K, Jones DA, Ozkor M et al. Coronary Revascularization in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis. JACC: Cardiovascular Interventions. 2021;14(19):2083–96. DOI: 10.1016/j.jcin.2021.07.058
21. Hasdai D, Lev EI, Behar S, Boyko V, Danchin N, Vahanian A et al. Acute coronary syndromes in patients with pre-existing moderate to severe valvular disease of the heart: lessons from the EuroHeart Survey of acute coronary syndromes. European Heart Journal. 2003;24(7):623–9. DOI: 10.1016/S0195-668X(02)00742-X
22. Crimi G, Montalto C, Ferri LA, Piatti L, Bossi I, Morici N et al. Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study. Canadian Journal of Cardiology. 2020;36(7):1104–11. DOI: 10.1016/j.cjca.2019.11.014
23. Singh GK, Van Der Bijl P, Goedemans L, Vollema EM, Abou R, Ajmone Marsan N et al. Prevalence of Aortic Valve Stenosis in Patients With ST-Segment Elevation Myocardial Infarction and Effect on Long-Term Outcome. The American Journal of Cardiology. 2021;153:30–5. DOI: 10.1016/j.amjcard.2021.05.012
24. Muzafarova T, Motovska Z. The role of pre-existing left-sided valvular heart disease in the prognosis of patients with acute myocardial infarction. Frontiers in Cardiovascular Medicine. 2024;11:1465723. DOI: 10.3389/fcvm.2024.1465723
25. Patlolla SH, Maqsood MH, Belford PM, Kumar A, Truesdell AG, Shah PB et al. Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States. American Heart Journal Plus: Cardiology Research and Practice. 2022;23:100217. DOI: 10.1016/j.ahjo.2022.100217
26. Abraham B, Farina JM, Fath A, Abdou M, Elbanna M, Suppah M et al. The impact of moderate aortic stenosis in acute myocardial infarction: A multicenter retrospective study. Catheterization and Cardiovascular Interventions. 2023;102(1):159–65. DOI: 10.1002/ccd.30676
27. Chumakova O.S., Selezneva N.D., Evdokimova M.A., Osmolovskaya V.S., Kochkina M.S., Aseycheva O.Yu. et al. Prognostic significance of aortic stenosis in patients suffering exacerbation of coronary heart disease. Кардиология. 2011;51(1):23–8.
28. Chew NWS, Zhang A, Ong J, Koh S, Kong G, Ho YJ et al. Longterm Prognosis in Patients With Concomitant Acute Coronary Syndrome and Aortic Stenosis. Canadian Journal of Cardiology. 2022;38(8):1220–7. DOI: 10.1016/j.cjca.2022.03.010
29. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third Universal Definition of Myocardial Infarction. Circulation. 2012;126(16):2020–35. DOI: 10.1161/CIR.0b013e31826e1058
30. Sherashov A.V., Shilova A.S., Pershina E.S., Shchekochikhin D.Yu., Svet A.V., Gilyarov M.Yu. Myocardial infarction with nonobstructive coronary arteries. Kardiologiia. 2020;60(3):89–95. DOI: 10.18087/cardio.2020.3.n881
31. McConkey HZR, Marber M, Chiribiri A, Pibarot P, Redwood SR, Prendergast BD. Coronary Microcirculation in Aortic Stenosis. Circulation: Cardiovascular Interventions. 2019;12(8):e007547. DOI: 10.1161/CIRCINTERVENTIONS.118.007547
32. Yan AT, Koh M, Chan KK, Guo H, Alter DA, Austin PC et al. Association Between Cardiovascular Risk Factors and Aortic Stenosis. Journal of the American College of Cardiology. 2017;69(12):1523–32. DOI: 10.1016/j.jacc.2017.01.025
33. Deb N, Ali MS, Mathews A, Chang Y-W, Lacerda CM. Shear type and magnitude affect aortic valve endothelial cell morphology, orientation, and differentiation. Experimental Biology and Medicine. 2021;246(21):2278–89. DOI: 10.1177/15353702211023359
34. Ajmone Marsan N, Delgado V, Shah DJ, Pellikka P, Bax JJ, Treibel T et al. Valvular heart disease: shifting the focus to the myocardium. European Heart Journal. 2023;44(1):28–40. DOI: 10.1093/eurheartj/ehac504
35. Scarsini R, Gallinoro E, Ancona MB, Portolan L, Paolisso P, Springhetti P et al. Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing TAVI. EuroIntervention. 2024;20(5):e289–300. DOI: 10.4244/EIJ-D-23-00735
36. Alahdab F, Ahmed AI, Nayfeh M, Han Y, Abdelkarim O, Alfawara MS et al. Myocardial Blood Flow Reserve, Microvascular Coronary Health, and Myocardial Remodeling in Patients With Aortic Stenosis. Journal of the American Heart Association. 2024;13(11):e033447. DOI: 10.1161/JAHA.123.033447
37. Belur AD, Solankhi N, Sharma R. Management of coronary artery disease in patients with aortic stenosis in the era of transcatheter aortic valve replacement. Frontiers in Cardiovascular Medicine. 2023;10:1139360. DOI: 10.3389/fcvm.2023.1139360
38. Sellers SL, Gulsin GS, Zaminski D, Bing R, Latib A, Sathananthan J et al. Platelets: Implications in Aortic Valve Stenosis and Bioprosthetic Valve Dysfunction From Pathophysiology to Clinical Care. JACC: Basic to Translational Science. 2021;6(12):1007–20. DOI: 10.1016/j.jacbts.2021.07.008
39. Goldsweig AM, Lotfi A. Beyond Magic: How to Differentiate the Acute Presentations of Aortic Stenosis and Myocardial Infarction? Cardiovascular Revascularization Medicine. 2022;43:18–9. DOI: 10.1016/j.carrev.2022.07.013
40. Patel KP, Chahal A, Mullen MJ, Rathod K, Baumbach A, Lloyd G et al. Acute Decompensated Aortic Stenosis: State of the Art Review. Current Problems in Cardiology. 2023;48(1):101422. DOI: 10.1016/j.cpcardiol.2022.101422
41. Bula K, Ćmiel A, Sejud M, Sobczyk K, Ryszkiewicz S, Szydło K et al. Electrocardiographic criteria for left ventricular hypertrophy in aortic valve stenosis: Correlation with echocardiographic parameters. Annals of Noninvasive Electrocardiology. 2019;24(5):e12645. DOI: 10.1111/anec.12645
42. Komlev A.E., Blinova E.V., Sakhnova T.A., Saidova M.A., Imaev T.E. Features of 12-lead electrocardiography in patients with critical aortic stenosis. Russian Journal of Cardiology. 2023;28(7):25–31. DOI: 10.15829/1560-4071-2023-5367
43. Heger J, Trimaille A, Kibler M, Marchandot B, Peillex M, Carmona A et al. Electrocardiographic Strain Pattern Is a Major Determinant of Rehospitalization for Heart Failure After Transcatheter Aortic Valve Replacement. Journal of the American Heart Association. 2021;10(3):e014481. DOI: 10.1161/JAHA.119.014481
44. Wald DS, Williams S, Bangash F, Bestwick JP. Watchful Waiting in Aortic Stenosis: The Problem of Acute Decompensation. The American Journal of Medicine. 2018;131(2):173–7. DOI: 10.1016/j.amjmed.2017.08.027
45. Patel KP, Rathod K, Akhtar M, Jones DA, Ozkor M, Kennon S et al. Differentiating Between Acute Decompensated Aortic Stenosis and Myocardial Infarction. Cardiovascular Revascularization Medicine. 2022;43:13–7. DOI: 10.1016/j.carrev.2022.04.003
46. Zern EK, Frank RC, Yucel E. Valvular Heart Disease in the Cardiac Intensive Care Unit. Critical Care Clinics. 2024;40(1):105–20. DOI: 10.1016/j.ccc.2023.05.002
47. Kolte D, Khera S, Vemulapalli S, Dai D, Heo S, Goldsweig AM et al. Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions. 2018;11(12):1175–85. DOI: 10.1016/j.jcin.2018.03.002
48. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. New England Journal of Medicine. 2010;363(17):1597–607. DOI: 10.1056/NEJMoa1008232
49. Piriou P, Manigold T, Letocart V, Le Ruz R, Schurtz G, Vincent F et al. Outcomes of emergency transcatheter aortic valve replacement in patients with cardiogenic shock: A multicenter retrospective study. Cathe terization and Cardiovascular Interventions. 2022;99(7):2117–24. DOI: 10.1002/ccd.30194
50. Goel K, Shah P, Jones BM, Korngold E, Bhardwaj A, Kar B et al. Outcomes of transcatheter aortic valve replacement in patients with cardiogenic shock. European Heart Journal. 2023;44(33):3181–95. DOI: 10.1093/eurheartj/ehad387
51. Prendergast BD, Patterson T, Redwood S. Transcatheter aortic valve implantation in patients with severe aortic stenosis and cardiogenic shock: an important step forward. European Heart Journal. 2023;44(33):3196–8. DOI: 10.1093/eurheartj/ehad471
52. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Revista Española de Cardiología (English Edition). 2022;75(6):524. DOI: 10.1016/j.rec.2022.05.006
53. Paradis J-M, Fried J, Nazif T, Kirtane A, Harjai K, Khalique O et al. Aortic stenosis and coronary artery disease: What do we know? What don’t we know? A comprehensive review of the literature with proposed treatment algorithms. European Heart Journal. 2014;35(31):2069–82. DOI: 10.1093/eurheartj/ehu247
54. Kang D-H, Park S-J, Lee S-A, Lee S, Kim D-H, Kim H-K et al. Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis. New England Journal of Medicine. 2020;382(2):111–9. DOI: 10.1056/NEJMoa1912846
55. Banovic M, Putnik S, Penicka M, Doros G, Deja MA, Kockova R et al. Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial. Circulation. 2022;145(9):648–58. DOI: 10.1161/CIRCULATIONAHA.121.057639
56. Thompson CR. Acute Coronary Syndrome and Aortic Stenosis: A Lethal Combo! Canadian Journal of Cardiology. 2022;38(8):1130–1. DOI: 10.1016/j.cjca.2022.05.006
57. Mukanova M.B., Kopylov F.Yu., Komarov R.N., Serebrennikov I.I., Gafurov F.S., Khuziakhmedov A.N. et al. Acute coronary syndrome in patients with aortic valve stenosis. Practical medicine. 2023;21(2):73–8. DOI: 10.32000/2072-1757-2023-2-73-78
58. Li S, Liu H, Zhang Y, Zhang M, Zhang H, Zhu C et al. Prognostic role of lipoprotein(a) in atherosclerotic cardiovascular disease risk from a perspective on current risk stratification. MedComm. 2024;5(11):e773. DOI: 10.1002/mco2.773
59. Arsenault BJ, Loganath K, Girard A, Botezatu S, Zheng KH, Tzolos E et al. Lipoprotein(a) and Calcific Aortic Valve Stenosis Progression: A Systematic Review and Meta-Analysis. JAMA Cardiology. 2024;9(9):835–42. DOI: 10.1001/jamacardio.2024.1882
60. Capoulade R, Chan KL, Yeang C, Mathieu P, Bossé Y, Dumesnil JG et al. Oxidized Phospholipids, Lipoprotein(a), and Progression of Calcific Aortic Valve Stenosis. Journal of the American College of Cardiology. 2015;66(11):1236–46. DOI: 10.1016/j.jacc.2015.07.020
61. Capoulade R, Yeang C, Chan KL, Pibarot P, Tsimikas S. Association of Mild to Moderate Aortic Valve Stenosis Progression With Higher Lipoprotein(a) and Oxidized Phospholipid Levels: Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiology. 2018;3(12):1212–7. DOI: 10.1001/jamacardio.2018.3798
62. Kim A-R, Ahn J-M, Kang D-Y, Jun TJ, Sun BJ, Kim HJ et al. Association of Lipoprotein(a) With Severe Degenerative Aortic Valve Stenosis. JACC: Asia. 2024;4(10):751–60. DOI: 10.1016/j.jacasi.2024.07.007
63. Bhatia HS, Ma GS, Taleb A, Wilkinson M, Kahn AM, Cotter B et al. Trends in testing and prevalence of elevated Lp(a) among patients with aortic valve stenosis. Atherosclerosis. 2022;349:144–50. DOI: 10.1016/j.atherosclerosis.2022.01.022
64. Voevoda M.I., Ezhov M.V., Konovalov G.A., Zheleznyakova I.A., Pokrovsky S.N., Alieva A.S. et al. New opportunities to use a lipoprotein(a) blood test in real-life clinical practice. Resolution of the expert council. Russian Medical Journal. 2024;9:40–4. DOI: 10.32364/2225-22822024-9-7
Review
For citations:
Barbarash O.L., kashtalap V.V. Aortic Valve Stenosis and Acute Coronary Syndrome. Obvious Answers to Non-Obvious Questions. Kardiologiia. 2025;65(5):41-51. (In Russ.) https://doi.org/10.18087/cardio.2025.5.n2886