[Preoperative coronarography in heart valve disease patients. A probability analysis of coronary lesion].
OBJECTIVE
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.


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.
Gómez Doblas
J J
JJ
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga. jjgomez@inforvip.es
Jiménez Navarro
M
M
Rodríguez Bailón
I
I
Alonso Briales
J H
JH
Hernández García
J M
JM
Montiel Trujillo
A
A
Rueda Calle
E
E
Barrera Cordero
A
A
Castillo Castro
J L
JL
Alvarez de Cienfuegos Rivera
F
F
de Teresa Galván
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015995:Prevalence; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors