Prevalence of Coronary Artery Disease in Rheumatic Patients Undergoing Valve Surgeries in Nepal

Abstract

Background: Preoperative coronary angiogram is routinely performed in high risk age-group in rheumatic population undergoing valve surgery at our centre. Preoperative angiogram itself carries risks. We sought to evaluate the prevalence of coronary artery disease in those patients so that recommendations on preoperative angiogram can be made. Methods: We reviewed medical records of patients above 35 years who underwent valve surgery from January 2015 to July 2017. We defined significant coronary artery disease as ≥50% stenosis in one or more major coronaries. Overall prevalence and age-specific prevalence were determined. Results: A total of 675 patients above 35 years of age undergoing valve surgery were assessed for eligibility. Among them, 563 (84.3%) patients had rheumatic heart disease. However, only 337 patients had undergone preoperative angiogram and were included in the analysis. Overall prevalence of coronary artery disease was 13(2.3%). Agespecific prevalence was as follows: age-group 40-50 years 0 of 127 patients (0%), 51-55 years 6 of 95 patients (6.3%), 55-60 years 1 of 56 patients (1.7%), and more than 60 years 6 of 52 patients (11.5%). Prevalence did not significantly differ between male and female population. Conclusion: The prevalence of coronary artery disease in rheumatic patients requiring valve replacement seems to be lower compared to the available prevalence data of general Nepalese population. There were no cases of angiographically significant coronary heart disease in the age between 40-50 years. However, the results of this study should be inferred with caution and prospectively planned study with risk factor analysis is warranted.