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Angina pectoris in severe aortic stenosis
1Mount Sinai Hospital, Cardiac Catheterization Laboratory, New York, NY 10029, USA.
Insights
In very elderly patients with severe aortic stenosis, angina pectoris strongly predicts coronary artery disease. Its absence suggests no significant coronary artery disease, aiding treatment decisions.
Area of Science:
- Cardiology
- Geriatric Medicine
Background:
- Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD).
- Predicting CAD in very elderly patients undergoing AS treatment is clinically important.
Purpose of the Study:
- To evaluate angina pectoris as a predictor of significant CAD in patients aged ≥70 years with severe AS.
- To assess the diagnostic value of angina in this specific high-risk population.
Main Methods:
- Retrospective analysis of 90 patients (age ≥70) referred for balloon aortic valvuloplasty.
- Coronary angiography performed before valvular intervention.
- Patients categorized based on presence or absence of angina pectoris.
Main Results:
- 78% of patients with angina had obstructive CAD (>50% stenosis) versus 17% without angina (p < 0.01).
- Angina pectoris demonstrated 78% sensitivity and 82% specificity for obstructive CAD.
- Absence of angina was highly predictive of the absence of obstructive CAD.
Conclusions:
- Angina pectoris is a significant predictor of obstructive CAD in very elderly patients with severe AS.
- The absence of angina can reliably rule out significant CAD in this population.
- Clinical decisions regarding AS management in the elderly should not be delayed by the need for routine coronary angiography.
Abstract:
We studied the value of angina pectoris as a predictor of significant coronary artery disease (CAD) in very elderly patients with severe aortic stenosis (AS). The study population consisted of patients with age at least 70 years who were referred for balloon aortic valvuloplasty (n = 90 patients). Routine coronary angiography was performed before the valvular intervention. Patients were grouped according to the presence or absence of angina pectoris. Of the patients with angina pectoris, 78% had obstructive (>50% diameter stenosis) CAD on coronary angiogram, while only 17% of patients without angina pectoris had obstructive CAD (p < 0.01). Angina pectoris had a sensitivity of 78% and a specificity of 82% for prediction of obstructive CAD. This suggests that in elderly patients with severe AS, the presence of angina pectoris is a strong determinant of CAD, and the absence of angina strongly suggests absence of obstructive CAD. In a very elderly population, appropriate decision-making with respect to AS management should not await diagnostic coronary angiography.