Prevalence and Clinical Risk Factors of Coronary Artery Disease in Rheumatic and Non-Rheumatic Valvular Heart Disease Patients Undergoing Preoperative Coronary Angiography

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Danon Kaewkes
Keetapong Pongtipakorn


Background and Objective: Preoperative coronary angiography (CAG) is an essential procedure before conducting a valvular operation. However, it is invasive and may cause serious complications. Identification of the prevalence of coronary artery disease (CAD) and its clinical risk factors in patients with rheumatic (RHD) compared to those with non-rheumatic heart disease (NRHD) should result in more appropriate patient selection and reduction of the over-utilization of CAG.

Methods: We conducted a retrospective cross-sectional study by reviewing the records of all consecutive patients with valvular heart disease who underwent preoperative CAG under our care at Queen Sirikit heart center from April 2015 - April 2018.

Results: A total of 238 patients were included in this study, 110 (46.2%) of whom suffered from RHD and 128 (53.8%) of whom had NRHD. The overall prevalence of significant CAD was 13.9% (20.3% in NRHD and 6.4% in RHD, p-value = 0.002). Overall, age over 50 years, diabetes mellitus, hypertension, and chronic kidney disease stage 3 or higher were risk factors for CAD and RHD was a protective factor according to univariate analysis. However, only hypertension and age remained significant after multivariate analysis. In contrary, female patients with rheumatic etiology and had no diabetes mellitus and hypertension were the lowest-risk subgroups.

Conclusion: The prevalence of CAD was lower in patients with RHD compared to those with NRHD. However, the clinical risk factors that predicted CAD in both groups were conventional CAD risks. Thus, alternative non-invasive preoperative coronary studies should be an option in RHD patients with low traditional CAD risk factors.


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