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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
10:03

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Published on: January 28, 2020

Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

S S Lin1, M S Lauer, C R Asher

  • 1Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.

The Journal of Thoracic and Cardiovascular Surgery
|April 28, 2001
PubMed

Insights

A new clinical model accurately identifies patients with low risk of obstructive coronary artery disease before mitral valve surgery. This allows for safely avoiding routine coronary angiography in low-risk individuals, saving costs.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Preventive Cardiology

Background:

  • Obstructive coronary artery disease (CAD) is a significant concern in patients undergoing operations for mitral valve degeneration.
  • Routine coronary angiography is often performed preoperatively, but its utility in low-risk patients is debatable.
  • Developing a risk stratification model can optimize patient selection for invasive procedures.

Purpose of the Study:

  • To develop and validate a clinical model for estimating obstructive CAD risk in patients undergoing mitral valve surgery.
  • To assess the model's ability to identify low-risk patients who may not require routine coronary angiography.
  • To demonstrate the potential clinical utility and cost-effectiveness of the developed model.

Main Methods:

  • Analysis of 722 patients without prior ischemic heart disease undergoing mitral valve prolapse operations and coronary angiography.
  • Development of a bootstrap-validated logistic regression model using clinical risk factors to predict obstructive CAD.
  • Definition of obstructive CAD as >=50% luminal narrowing in major epicardial vessels.

Main Results:

  • 19% of patients had obstructive coronary atherosclerosis; independent predictors included age, male sex, hypertension, diabetes, and hyperlipidemia.
  • The logistic model identified 220 patients (30%) as low-risk, with only 1.3% having single-vessel disease and none having multivessel disease.
  • The model demonstrated good discrimination (AUC=0.84) and could potentially eliminate 30% of angiograms, saving $430,000 per 1000 patients.

Conclusions:

  • A clinical prediction model using standard factors reliably estimates obstructive CAD prevalence in patients undergoing mitral valve prolapse operations.
  • The model effectively identifies low-risk individuals.
  • Routine preoperative coronary angiography can be safely omitted in low-risk patients identified by this model.
Abstract

Keywords:
NASA Discipline CardiopulmonaryNon-NASA Center

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