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[Preoperative coronary angiography in valve patients. Criteria for indication in a determined population]
J C Muñoz San José1, L de la Fuente Galán, I Garcimartín Cerrón
1Servicio de Cardiología, Hospital Universitario, Valladolid.
Insights
Preoperative coronary angiography is recommended for patients with valvular heart disease who are older males (≥60) or females (≥65), or younger patients with angina or risk factors for coronary artery disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Preoperative coronary angiography indications for valvular heart disease vary geographically.
- Understanding local prevalence of coronary artery disease (CAD) is crucial.
Purpose of the Study:
- To establish criteria for preoperative coronary angiography in patients with valvular heart disease.
- To determine the prevalence of significant CAD in this patient group.
Main Methods:
- Retrospective study of 511 patients with valvular disease undergoing preoperative coronary angiography.
- Analysis of demographic data, symptoms, and CAD risk factors.
- Target CAD prevalence threshold set at ≥5% for indication.
Main Results:
- Overall significant CAD prevalence was 20.3%.
- Higher prevalence in patients with angina (35.3%) and risk factors (28%).
- Independent predictors for CAD: age, angina, and risk factors.
Conclusions:
- Preoperative coronary angiography indicated for males ≥60 and females ≥65 years old.
- Indicated for younger patients presenting with angina or risk factors.
- Criteria apply regardless of specific valvulopathy.
Background And Purpose:
The indication for preoperative coronary angiography in patients with valvular heart disease depends on the prevalence of coronary disease in these patients, which differs among different geographical areas. Our aim was to determine the indication criteria for preoperative coronary angiography in our population.
Methods:
We studied retrospectively the prevalence of significant coronary disease in 511 consecutive patients with valvular disease diagnosed by non-invasive methods, who underwent preoperative coronary angiography from August/1991 to July/1996. We analyzed in each patient: demographic data, symptoms and presence of risk factors for coronary artery disease. We considered that preoperative coronary angiography had to be performed on patients who had a coronary artery disease prevalence > or = 5%.
Results:
Mean age was 64 +/- 10 years (51% male). There was mitral valvulopathy in 135 patients, aortic in 234 and combined mitro-aortic in 142. Angina was present in 30% of patients, and risk factors for coronary artery disease in 52%. The prevalence of significant coronary disease was 20.3%. It was significantly higher in patients with angina (35.3% versus 13.8% in patients without angina) and in those with risk factors (28% versus 12.2% in patients without risk factors); no differences between valvulopathies were found. Age was significantly higher in patients with coronary disease (69 +/- 8 versus 63 +/- 10 years). Multivariate analysis showed three independent predictors for significant coronary disease: 1) age; 2) previous angina, and 3) risk factors. Regarding the prevalence of significant coronary disease in patients neither angina nor risk factors was < 5% in males who were under 60 years old (1 man; 3.3%) and in females under 65 years old (2 women; 3.5%).
Conclusions:
In our reference population and in others with a similar cardiovascular profile, preoperative coronary angiography is indicated in males who are > or = 60 years old and in females who are > or = 65 years old, and in younger patients who present angina or risk factors, regardless of the valvulopathy present.