title: Prevalence and impact of coronary artery disease in patients with pulmonary arterial hypertension.
abstract: The occurrence and impact of coronary artery disease (CAD) among patients with pulmonary arterial hypertension (PAH) are unknown. We aimed to determine the prevalence, clinical correlates, and effect of CAD in patients with PAH. We reviewed the medical records of consecutive patients diagnosed with PAH at a university-based referral center for pulmonary vascular disease from January 1990 to May 2010. The patients systematically underwent right heart catheterization and coronary angiography as a part of their evaluation. The patients with PAH with CAD (defined as ≥50% stenosis in ≥1 major epicardial coronary artery) were compared to patients without CAD. Among the 162 patients with PAH, the prevalence of CAD was 28.4%. The presence of CAD was associated with older age (66.6 ± 11.5 vs 49.2 ± 14.0 years, p <0.001), systemic hypertension, and dyslipidemia. The patients with PAH and CAD had a lower mean pulmonary arterial pressure (44.6 ± 11.1 vs 49.2 ± 14.0 mm Hg; p = 0.02) than patients without CAD. During a median follow-up of 36 months, 73 patients died. The presence of CAD was a predictor of all-cause mortality on univariate analysis (hazard ratio 1.97, 95% confidence interval 1.21 to 3.20) but not on multivariate analysis, which identified older age (hazard ratio 1.03, 95% confidence interval 1.01 to 1.05) and right atrial pressure (hazard ratio 1.08, 95% confidence interval 1.03 to 1.14) as the only independent predictors. In conclusion, our study has demonstrated that CAD is common among patients with PAH. CAD prevalence increases with age, dyslipidemia, and hypertension, but we did not detect an independent prognostic effect of CAD on mortality.
authors: Center for Pulmonary Vascular Disease, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
authors: Avi
authors: A
authors: Shimony
authors: Mark Jeffrey
authors: MJ
authors: Eisenberg
authors: Lawrence Glenn
authors: LG
authors: Rudski
authors: Robert
authors: R
authors: Schlesinger
authors: Jonathan
authors: J
authors: Afilalo
authors: Dominique
authors: D
authors: Joyal
authors: Leonidas
authors: L
authors: Dragatakis
authors: Andrew
authors: A
authors: Hirsch
authors: Kim
authors: K
authors: Boutet
authors: Benjamin Daniel
authors: BD
authors: Fox
authors: David
authors: D
authors: Langleben