Prevalence and predictors of significant coronary artery disease in Turkish patients who undergo heart valve surgery.
OBJECTIVE
The presence of significant atherosclerotic coronary artery disease (CAD) in patients with valvular heart disease is an important predictor of perioperative mortality. The prevalence of CAD in patients undergoing valvular heart surgery is 20-40% in industrialized countries. The study aim was to determine CAD prevalence in Turkish patients undergoing valvular heart surgery, and to identify predictors of its presence.


METHODS
A total of 760 patients (357 males, 403 females; mean age 54.4+/-18.1 years) who underwent coronary angiography before valvular surgery between 1995 and 2000 was enrolled retrospectively. Single- and multi-valve involvement was present in 46% and 54% of patients, respectively. Patients with ischemic mitral regurgitation were excluded from the study. Significant CAD was defined as the presence of > or =50% diameter stenosis anyone of the coronary arteries. The presence of angina pectoris, and of risk factors (e.g. hypertension, smoking, diabetes mellitus (DM), hyperlipidemia, family history of CAD) were sought in all patients. Predictors of CAD were identified by logistic regression analysis.


RESULTS
Significant CAD was present in 15.8% of patients (24% males, 9% females) (p <0.001); the highest prevalence was in those with aortic stenosis (p <0.05). CAD was not seen in young patients (aged <45 years) with none of the above-mentioned risk factors. The highest correlation between CAD and risk factors was family history of CAD, followed by DM, hyperlipidemia, hypertension and smoking, in decreasing order.


CONCLUSIONS
The study results showed that CAD in patients with valvular heart disease was less prevalent in Turkey than in industrialized countries. The incidence of coronary lesions rises notably from the age of 50 years in both males and females. Coronary angiography before valvular heart surgery could be omitted in young patients (age <45 years) with none of the coronary risk factors, or without angina.
Sonmez
Kenan
K
Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Gencbay
Murat
M
Akcay
Ahmet
A
Yilmaz
Ahmet
A
Pala
Selcuk
S
Onat
Ozgur
O
Duran
Nilufer Eksi
NE
Degertekin
Muzaffer
M
Turan
Fikret
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology