Clinical relevance of coronary angiography at the time of percutaneous closure of a patent foramen ovale.
BACKGROUND
The value of incidental coronary angiography during percutaneous shunt closure to screen for asymptomatic coronary artery disease (CAD) is unknown.


METHODS
On the occasion of percutaneous closure of patent foramen ovale (PFO), incidental coronary angiography routinely offered to men >40 and women >50 years, or younger patients with particular risk patterns, was performed in 575 patients (64% men, mean age 55 +/- 10 years, mean 1.5 +/- 1.1 cardiovascular risk factors) without overt history, signs, or symptoms of CAD.


RESULTS
CAD was found in 164 patients (29%); 53 (9%) had >or=50% diameter stenoses. Thirty patients (5%) had one-vessel, 13 (2%) two-vessel, and 10 (2%) three-vessel disease. Patients with CAD (n = 164) were older (60 +/- 9 vs. 53 +/- 10 years; P < 0.0001), more frequently male (76% vs. 59%; P = 0.0002), and had a higher body mass index (26.5 +/- 4.0 vs. 25.4 +/- 4.6; P = 0.006) and more cardiovascular risk factors (2.0 +/- 1.1 vs. 1.2 +/- 1.0; P < 0.0001). There were six procedural complications (1%). Two were unequivocally related to coronary angiography: one minor stroke (diplopia), and one iatrogenic dissection of the right coronary ostium requiring stenting. Furthermore, four arteriovenous fistulae at the puncture site requiring elective surgical closure were possibly related to coronary angiography. Forty-five patients (8% of total) underwent percutaneous (n = 43) or surgical (n = 2) revascularization.


CONCLUSIONS
In selected asymptomatic patients referred for percutaneous PFO closure, incidental coronary angiography discloses a rather high prevalence of clinically unsuspected CAD. These findings are relevant not only for timely revascularization but also for maintenance of long-term antiplatelet therapy beyond the few months recommended after PFO closure.
Wahl
Andreas
A
Cardiology, University Hospital Bern, Switzerland.
Praz
Fabien
F
Seiler
Christian
C
Windecker
Stephan
S
Meier
Bernhard
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D033162:Incidental Findings; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects; D016896:Treatment Outcome