title: Acute coronary syndromes in patients with prosthetic heart valves-a case-series.
abstract: BACKGROUND
  There are few reports regarding acute coronary syndromes (ACS) in patients with prosthetic heart valves (PHV), mostly attributing the ACS to a PHV-derived coronary embolus.
  
  
  OBJECTIVE
  To characterize a case-series of ACS patients with PHV.
  
  
  METHODS
  All patients in our institution with previous PHV surgery and ACS during 1996-2005 were retrospectively analysed.
  
  
  RESULTS
  We identified 40 patients from the 15,878 patient database, whose mean age was 72.5 +/- 12.5 years and of whom 21 were male. The majority (n=28) had mechanical valves; 24 patients (60%) had an aortic prosthetic valve, 9 patients (22.5%) had a mitral valve prosthesis and 7 patients (17.5%) had both. The majority of patients had > or = 2 risk factors for atherosclerotic disease. The median time from the PHV implantation to the subsequent ACS was 8.0 (4.7-12.1) years. Most patients had non-ST-segment elevation ACS rather than ST-segment elevation ACS (32 patients versus 8 patients). 12 patients (30%) had moderate to severe left ventricular dysfunction and 2 of them presented with cardiogenic shock. Atrial fibrillation on hospital admission was noted in 13 patients (32.5%). ACS management included coronary angiography in 32 patients (80%) which revealed coronary disease in 93%. Only 2 patients had normal coronary arteries and PHV-derived coronary emboli. The most frequent in-hospital complication was heart failure (n=11, 27.5%).
  
  
  CONCLUSIONS
  Patients with PHV and ACS are a rare subgroup, more likely to be elderly with risk factors for atherosclerotic disease and to present with non-ST-segment-elevation ACS. The pathogenesis for ACS is commonly coronary atherosclerotic disease rather than PHV-derived emboli.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Petah Tikva, Tel Aviv University, Israel.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.forename: Avital
authors.initials: A
authors.lastname: Porter
authors.forename: Nahum
authors.initials: N
authors.lastname: Cohen
authors.forename: Eugene
authors.initials: E
authors.lastname: Abramson
authors.forename: Aviv
authors.initials: A
authors.lastname: Mager
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Alexander
authors.initials: A
authors.lastname: Sagie
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001281:Atrial Fibrillation / Q000453:epidemiology; D003131:Combined Modality Therapy; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged