Screening coronary angiography prior to surgery in rheumatic valvular heart disease: a study of 2,188 patients.
OBJECTIVE
The role of screening coronary angiography in Asian Indian patients with rheumatic heart disease (RHD) due to undergo valve replacement surgery is unclear. Hence, the study aim was to determine the prevalence of coronary artery disease (CAD), and to monitor its correlation with demographic variables and valvular lesion type, in this patient group.


METHODS
A retrospective analysis of 2,188 consecutive patients (1,319 men, 869 women; mean age 48 +/- 7 years) with rheumatic valvular heart disease was conducted. The patients underwent preoperative coronary angiography in a tertiary care hospital between 1991 and 2004.


RESULTS
The overall prevalence of CAD was 11% (12% in men, 8% in women). The prevalence of CAD in the age groups of 40-44, 45-49, 50-54, 55-59 and > 60 years was 4%, 5%, 9%, 15% and 20% in men, and 2%, 2%, 3%, 7% and 10% in women, respectively. Both, age and male gender were independently associated with the occurrence of CAD (p < 0.01). The unadjusted odds ratio of having CAD was highest in patients with aortic stenosis (2.08; p < 0.01), and lowest in those with aortic regurgitation (AR) (0.58; p = 0.018). Those patients with AR also showed an independent inverse association with the occurrence of CAD (p = 0.006).


CONCLUSIONS
The overall prevalence of CAD among Asian Indian patients with RHD was lower than that in patients from western countries. The cut-off age to perform coronary angiographic screening should be maintained at 40 years for men, and 55 years for women. The prevalence of CAD may be lower in those patients with AR.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Rajiv
R
Narang
Davinder S
DS
Chadha
Kashish
K
Goel
Sandeep
S
Mishra
Naveen
N
Bajaj
Sanjeev
S
Sharma
Nidhi
N
Gupta
Vinay K
VK
Bahl
D000328:Adult; D002985:Clinical Protocols; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery