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

Abstract

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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References

1. Wood AD, Mannu GS, Clark AB, Tiamkao S, Kongbunkiat K, Bettencourt-Silva JH, et al. Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study. Stroke 2016; 47: 2695-701.
2. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38: 2739-91.
3. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: e1159-e95.
4. Kruczan DD, Silva NA, Pereira Bde B, Romao VA, Correa Filho WB, Morales FE. Coronary artery disease in patients with rheumatic and non-rheumatic valvular heart disease treated at a public hospital in Rio de Janeiro. Arq Bras Cardiol 2008; 90: 197-203.
5. Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297-309.
6. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011;58(24):e44-122.
7. Li SC, Liao XW, Li L, Zhang LM, Xu ZY. Prediction of significant coronary artery disease in patients undergoing operations for rheumatic mitral valve disease. Eur J Cardiothorac Surg 2012;41(1):82-6.
8. Lin SS, Lauer MS, Asher CR, Cosgrove DM, Blackstone E, Thomas JD, et al. Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration. J Thorac Cardiovasc Surg 2001; 121: 894-901.
9. Yan T, Zhang GX, Li BL, Han L, Zang JJ, Li L, et al. Prediction of coronary artery disease in patients undergoing operations for rheumatic aortic valve disease. Clin Cardiol 2012; 35: 707-11.
10. Chu PH, Chiang CW, Hsu LA, Lin KH, Cheng NJ, Kuo CT. Low prevalence of coronary arterial disease in Chinese adults with mitral stenosis. Chang Gung Med J 2001; 24: 97-102.
11. Catalan P, Leta R, Hidalgo A, Montiel J, Alomar X, Vilades D, et al. Ruling out coronary artery disease with noninvasive coronary multidetector CT angiography before noncoronary cardiovascular surgery. Radiology 2011; 258: 426-34.