Acute coronary syndromes in patients with prosthetic heart valves-a case-series.
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.
Iakobishvili
Zaza
Z
Department of Cardiology, Rabin Medical Center, Petah Tikva, Tel Aviv University, Israel.
Eisen
Alon
A
Porter
Avital
A
Cohen
Nahum
N
Abramson
Eugene
E
Mager
Aviv
A
Shapira
Yaron
Y
Sagie
Alexander
A
Battler
Alexander
A
Hasdai
David
D
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