Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis

Angina pectoris is a frequent symptom of severe valvular aortic stenosis (AS), even in the presence of normal coronary arteries. To determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris and coronary risk factors in severe isolated valvular AS patients. All cases of symptomatic AS patients who underwent aortic valve replacement and preoperative cardiac catheterization at the Central Chest Hospital between January 1, 1986 and December 31, 1996 were retrospectively analyzed. Excluded were those with multiple valvular disease, aortic regurgitation of grade 2 or more, and prior coronary or valve surgery. A total of ninety consecutive patients with severe AS (64 men and 26 women, mean age 58.94 years, range 38 to 71) were studied. Significant CAD (coronary diameter stenoses > or = 50%) was found in 15 patients (16.7%). Typical angina was present in 66.7 per cent of them but it was also found in 46.7 per cent of the non-CAD patients. This symptom had low positive predictive value (22%). Of the patients without angina (n = 45) 11.1 per cent had significant CAD, The negative predictive value of angina alone was thus 89 per cent. By univariate logistic regression, the statistically significant variables to discriminate those with or without significant CAD were age, history of hypertension, positive familial history of premature CAD, and cholesterol level. However, only age and hypertension were statistically significant by multivariate logistic regression analysis. Coronary arteriography can probably be omitted in severe valvular AS, especially those without a history of hypertension and < 40 years of age in men and < 50 years in women. For all other cases, coronary arteriography is recommended. In our study, angina pectoris is not a significant predictor for associated CAD.