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Prevalence of coronary artery disease in patients with valvular heart disease
Insights
Preoperative coronary angiography is useful for valvular heart disease patients with angina pectoris. Routine angiography can be omitted in younger patients without angina, with age cut-offs suggested for aortic and mitral valve disease.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Valvular heart disease necessitates thorough preoperative evaluation.
- Coronary artery disease (CAD) is a significant comorbidity in patients with valvular heart disease.
- The role of routine coronary angiography in this population requires clarification.
Purpose of the Study:
- To assess the utility of preoperative coronary angiography in patients with valvular heart disease.
- To determine the prevalence of significant CAD in this cohort.
- To evaluate the predictive value of angina pectoris for CAD in different types of valvular heart disease.
Main Methods:
- Coronary angiography was performed in 329 consecutive patients with valvular heart disease.
- Prevalence of significant CAD and asymptomatic CAD was calculated.
- Cost-benefit analysis was conducted to evaluate routine screening.
Main Results:
- Significant CAD was found in 32% of patients; asymptomatic CAD in 13%.
- Angina pectoris was a poor predictor of CAD in aortic valve disease but specific in mitral valve disease.
- Age cut-offs of 60 for aortic and 65 for mitral valve disease were suggested for selective angiography.
Conclusions:
- Coronary angiography is valuable for valvular heart disease patients presenting with angina pectoris.
- Selective screening based on age and symptoms can optimize resource allocation.
- Routine preoperative coronary angiography may not be necessary for all younger patients without angina.
Abstract:
To evaluate the usefulness of preoperatie coronary angiography in patients undergoing preoperative investigation because of valvular heart disease, we performed coronary angiography in a consecutive series of 329 patients. The prevalence of significant coronary artery disease was 32%. Asymptomatic coronary artery disease was present in 13%. Angina pectoris proved to be a poor predictor of coronary artery disease in aortic valve disease. In mitral valve disease, however, the specificity was high. A cost-benefit calculation was carried out in order to assess what advantage routine coronary angiography might have. According to this, coronary angiography should be performed in all patients suffering from valvular heart disease with angina pectoris, whereas it can be omitted in younger patients without angina. A cut-off point of 60 years seems appropriate for aortic valve disease and 65 years for mitral valve disease.