Prevalence of coronary artery disease in patients with isolated aortic valve stenosis
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Patients with aortic stenosis (AS) undergoing valve replacement rarely need routine coronary arteriography if they are asymptomatic. This approach can reduce risks and costs associated with invasive procedures for coronary artery disease screening.
Area of Science:
- Cardiology
- Vascular Medicine
- Cardiac Surgery
Background:
- Aortic stenosis (AS) is a significant valvular heart disease.
- Coronary artery disease (CAD) frequently coexists with AS.
- The necessity of routine coronary arteriography in AS patients is debated.
Purpose of the Study:
- To determine the prevalence of significant coronary artery disease (CAD) in patients with severe aortic stenosis (AS) requiring aortic valve replacement (AVR).
- To evaluate the correlation between chest pain symptoms and the presence of CAD in this patient cohort.
- To inform guidelines regarding the necessity of routine coronary arteriography before AVR.
Main Methods:
- Retrospective analysis of 88 consecutive patients with severe AS undergoing AVR at Hammersmith Hospital.
- Assessment of significant CAD defined as >50% reduction in luminal diameter.
- Correlation of CAD prevalence with patient symptoms (typical angina, atypical chest pain, no chest pain).
Main Results:
- Significant CAD was found in 34% of patients (22 out of 88).
- Prevalence of CAD was higher in patients with typical angina (45%) compared to atypical chest pain (15%).
- No patients free of chest pain had significant CAD.
Conclusions:
- Routine coronary arteriography may not be necessary for patients with AS who are free of chest pain.
- This approach can mitigate risks associated with coronary arteriography and improve cost-effectiveness.
- The findings are particularly relevant for patients requiring urgent aortic valve replacement.
Abstract:
The prevalence of significant coronary artery disease (reduction in luminal diameter by more than 50%) among 88 consecutive patients with aortic stenosis requiring aortic valve replacement at Hammersmith Hospital was examined. Twenty two (34%) patients had significant coronary disease. Nineteen of 42 (45%) patients with typical angina had coronary disease; three of 20 (15%) patients with atypical chest pain had coronary disease, while none of 26 patients free of chest pain had significant coronary disease. Risk factors for coronary disease were equally distributed among patients with and without significant luminal obstruction. Because of the small, but definite, hazard of coronary arteriography and in the interest of cost containment it is suggested that patients with aortic stenosis who are free of chest pain do not require routine coronary arteriography. This applies particularly to patients requiring urgent aortic valve replacement.