Coronary artery disease in patients with rheumatic and non-rheumatic valvular heart disease treated at a public hospital in Rio de Janeiro.
OBJECTIVE
to estimate the prevalence of coronary artery disease (CAD) in valvular heart disease of rheumatic (RVHD) and non-rheumatic (NVHD) etiology, assessing possible predictive factors for the presence of CAD.


METHODS
This is a cross-sectional study of a series of cases obtained from a pre-defined population, wherein 1,412 patients referred for heart surgery of any etiology were evaluated. Of these, 294 primary heart disease patients aged > or =40 submitted to cinecoronary arteriography (CA) were identified and studied.


RESULTS
patients with RVHD presented lower prevalence of CAD (4%) when compared to NVHD (33.61%), p<0.0001. The logistic regression analysis showed that age, typical angina-like chest pain (TACP), systemic arterial hypertension (SAH), diabetes and dyslipidemia were significantly related to CAD, and that the rheumatic etiology was not a disease determinant. Smoking and gender were clinically important in CAD, although not statistically significant. In the whole group, the Log-linear analysis showed that, regardless of the etiology, gender, age > or =55, SAH, TACP, diabetes and dyslipidemia were all related directly to CAD, with the latter three being the most important variables for the disease.


CONCLUSIONS
the prevalence of CAD among RVHD patients is low, whereas it is high among NVHD patients; the rheumatic etiology does not seem to have any beneficial effects on the prevalence of CAD; gender, age, SAH, TACP, dyslipidemia and diabetes were identified as being strongly associated with the presence of CAD. It is possible to define the criteria that indicate the need for pre-surgical CA in heart valve replacements, so that the standard indication after the age of 40 years can be avoided.
Kruczan
Dany David
DD
Instituto Estadual de Cardiologia do Rio de Janeiro Aloysio de Castro/IECAC, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ - Brazil. dkruczan@cardiol.br
Silva
Nelson Albuquerque de Souza e
NA
Pereira
Basílio de Bragança
Bde B
Romão
Vítor André
VA
Correa Filho
Wilson Braz
WB
Morales
Fidel Ernesto Castro
FE
D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D001938:Brazil / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D003430:Cross-Sectional Studies; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D009204:Myocardial Revascularization; D015995:Prevalence; D012214:Rheumatic Heart Disease / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery