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Published on: August 28, 2018
[Preoperative coronarography in heart valve disease patients. A probability analysis of coronary lesion]
J J Gómez Doblas1, M Jiménez Navarro, I Rodríguez Bailón
1Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga. jjgomez@inforvip.es
Insights
Patients undergoing valve replacement surgery may avoid unnecessary coronary angiography. A low prevalence of coronary artery disease exists in those without prior angina, hypertension, diabetes, or tobacco use, particularly if under 65.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Preoperative coronary angiography is standard for valve replacement surgery patients.
- Current indications rely on age, gender, and angina history, not comprehensive risk factors.
- Predictive markers for coronary lesions in this population are needed.
Purpose of the Study:
- To identify predictors of coronary artery lesions in patients undergoing valve replacement.
- To refine patient selection for preoperative coronary angiography.
Main Methods:
- Retrospective analysis of 541 patients with valvular heart disease who had preoperative coronary angiography.
- Variables analyzed included age, gender, angina, hypertension, diabetes, tobacco use, and family history.
- Multivariate analysis correlated these variables with significant coronary lesions (>50% stenosis).
Main Results:
- Significant coronary artery disease (CAD) prevalence was 13.4% (73 patients).
- Predictors of CAD were previous angina (OR 3.3), tobacco use (OR 2.6), diabetes (OR 2.2), hypertension (OR 1.8), and age (OR 1.4).
- Patients lacking these risk factors had a 4% CAD probability; those under 65 had a 3% probability.
Conclusions:
- A low-risk group, defined by absence of prior angina and key risk factors (hypertension, diabetes, tobacco), has very low CAD prevalence.
- This stratification, especially in patients under 65, may help avoid routine preoperative coronary angiography.
- Identifying low-risk patients can optimize resource allocation and reduce unnecessary invasive procedures.
Introduction And Objectives:
The indication of preoperative coronary angiography is routinely performed for patients who are going to valve replacement surgery. The need of coronary angiography is based on age, gender and previous angina, but it is not usually based on risk factors. The purpose of this study has been to find markers to predict the probability of coronary lesion in this group of patients.
Patients And Methods:
We studied retrospectively a population of 541 patients with valvular heart disease who underwent preoperative coronary angiography from 1989 to 1994. Mean age was 61.8 (range 34-82). There were 301 men and 240 women. We analyzed in each patient different variables such as age, gender, previous angina, hypertension, diabetes mellitus, tobacco and familial predisposition. We correlated these variables with the presence of coronary lesion by multivariate analysis.
Results:
There were 73 patients with coronary lesion greater than 50%. The prevalence of significant coronary artery disease was 13.4%. Angina was present in 34.6%. The risk of coronary lesion was defined as odds ratio: previous angina 3.3; tobacco 2.6; diabetes 2.2; hypertension 1.8 and age 1.4. The others variables were not predictor of coronary lesion. The probability of coronary lesion in patients without those variables (angina, tobacco, diabetes, hypertension) was 4%. If we analyzed age, the probability of coronary lesion was 3% in patients under 65 years and 6% above 65 years.
Conclusions:
The lack of previous angina and at least the three risk factors described as predictors of coronary lesion (hypertension, tobacco and diabetes) can define a group of patients with a very low prevalence of coronary lesion, especially if they are under 65 years. It can allow us to avoid preoperatory coronary angiography in patients who undergo valve replacement.
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