Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Abstract

BackgroundThe prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement.ObjectivesTo evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score.MethodsCross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance.ResultsThe prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations.ConclusionsObstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.

Estatística Cardiovascular – Brasil 2021

“…However, in younger patients (<50 years) prevalence was much lower (3.3%). 209 These data are similar to those observed in another study that included 3736 patients (mean age, 43.7 years), in which prevalence of obstructive CAD combined with valvular heart disease was 3.42%. 207…”

“…Entretanto, nos mais jovens (<50 anos), a prevalência foi mais baixa (3,3%). 209 Esses dados são similares aos observados em outro estudo que incluiu 3.736 pacientes (idade média de 43,7 anos), nos quais a prevalência de DAC obstrutiva combinada com doença valvar do coração foi 3,42%. 207 Utilização e Custo da Atenção à Saúde…”

Estatística Cardiovascular – Brasil 2020

“…Entretanto, em pacientes mais jovens (<50 anos), a prevalência foi mais baixa (3,3%). 217 Esses dados são similares aos observados em outro estudo que incluiu 3.736 pacientes (idade média, 43,7 anos), nos quais a prevalência de DAC obstrutiva combinada com doença valvar do coração foi 3,42%. 191,203 determinantes genéticos e imunes da resposta às infecções estreptocócicas que leva a DCR, 229 preditores clínicos e relacionados a procedimento de eventos de curto e longo prazo após comissurotomia mitral percutânea, 211,230 além de um registro nacional de TAVI.…”

Frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery.

“…Obstructive coronary artery disease in patients of valvular heart disease has been reported to vary from 9%-41% in different studies. [8][9]19 In a recent large study involving 1308 patients by Anthony Matta and Nicolas Moussallemin Lebanese population has reported an overall prevalence for concurrent obstructive CAD of 27.75% in their patients who underwent heart valve surgery. 20 In Pakistan studies by Shaikh et al 21 and Gul et al 22 has reported overall prevalence of obstructive CAD of 31% respectively in their population cohorts.…”