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Published on: November 28, 2018
Coronary risk stratification of patients undergoing surgery for valvular heart disease
Rasmus Bo Hasselbalch1, Thomas Engstrøm2, Mia Pries-Heje1
1Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.
Insights
A new CT-valve score identifies patients who may not need invasive coronary angiography before heart valve surgery. This approach can reduce costs and radiation exposure, improving patient care for coronary artery disease (CAD).
Area of Science:
- Cardiology
- Medical Imaging
- Health Economics
Background:
- Multislice computed tomography (MSCT) offers a low-radiation alternative to coronary angiography (CAG) for assessing coronary artery disease (CAD) before valvular heart surgery.
- Previous studies indicate MSCT may lead to CAG re-evaluation in a third of patients, limiting its recommendation as a primary tool.
- Identifying low- to intermediate-risk CAD patients for MSCT could enhance cost-effectiveness and reduce procedural risks.
Purpose of the Study:
- To develop and validate a risk score to identify patients suitable for MSCT evaluation prior to valvular heart surgery.
- To determine if a risk-based approach can optimize the use of MSCT as a gatekeeper to CAG.
Main Methods:
- A national registry of patients undergoing CAG before valvular heart surgery was used to identify significant CAD risk factors.
- Logistic regression analysis was employed to develop the CT-valve score.
- The CT-valve score was validated on a separate patient cohort from another registry.
Main Results:
- The study included 4796 patients (2221 in the primary cohort, 2575 in the validation cohort); 23.5% and 29.9% had CAD, respectively.
- Identified CAD risk factors include male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, low ejection fraction, and diabetes.
- The CT-valve score successfully identified a subgroup (approximately one-third of patients) with a low CAD risk (around 10%).
Conclusions:
- A risk score incorporating established CAD risk factors can effectively identify patients who may benefit from MSCT.
- The CT-valve score shows potential for guiding the use of MSCT as a pre-procedural gatekeeper to CAG in valvular heart surgery patients.
- This strategy could lead to more efficient and safer cardiac evaluations by reducing unnecessary CAG procedures.
Background:
Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG.
Methods:
The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry.
Results:
The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%.
Conclusion:
A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery.
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