Prevalence and Risk Factors for Preoperative Coronary Artery Disease in Patients with Rheumatic and Non-Rheumatic Valvular Heart Disease
Natdanai Ketdao, MD1, Thanatcha Lertnimittham, MD1, Nidchakan Praphaphanthasak, MD1, Chawalit Wongbuddha, MD2,
Burabha Pussadhamma, MD3
Affiliation : 1Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Division of cardiovascular and thoracic surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 3Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Traditional atherosclerotic risk factors have been used to guide preoperative coronary angiography (CAG) in patients with valvular heart disease (VHD) who required valve surgery. However, the prevalence of coronary artery disease (CAD) differed among etiologies of VHD.
Objective: To evaluate differences in the prevalence of CAD across VHD etiologies and predictive factors for CAD.
Materials and Methods: The authors retrospectively reviewed patients aged ≥18 years with VHD who underwent valve surgery between January 2015 to December 2019. Patients with previously diagnosed significant CAD were excluded. CAD was diagnosed based on CAG findings with ≥50% stenosis of the left main coronary artery or ≥70% stenosis of other major epicardial vessels. The etiologies of VHD were classified according to echocardiographic characteristics. Clinical characteristics, echocardiographic parameters, and CAG results were collected from medical records and electronic databases. Univariable and multivariable analysis were performed to identify predictive factors of CAD.
Results: Total 917 patients undergoing valve surgery, 714 patients (77.9%) had preoperative CAG and CAD was diagnosed in 34 patients (4.8%). Rheumatic VHD accounted for half of the present study population (457 patients, 49.8%). CAD prevalence was significantly lower in patients with rheumatic VHD compared to non-rheumatic VHD (1.9% vs. 7.6%; p<0.001). From multivariable analysis, age ≥60 years was a significant predictor of CAD (OR 2.90; 95% CI, 1.03 to 8.18; p=0.04), while rheumatic VHD was associated with lower risk of CAD (OR 0.30; 95% CI, 0.09 to 0.94; p=0.04).
Conclusion: The prevalence of CAD in patients with rheumatic VHD requiring valve surgery is low. Including rheumatic VHD in the decisionmaking algorithm for preoperative CAG appears to be reasonable.
Keywords : Valvular heart disease; Rheumatic heart disease; Coronary artery disease; Coronary angiography
