title: Prevalence of coronary atherosclerosis in patients with aortic valve replacement.
abstract: BACKGROUND
  Because of a high prevalence of coronary artery disease in patients with aortic valve disease, coronary angiography is recommended before aortic valve replacement. However, during the last three decades, a decline in mortality due to coronary heart disease has been observed in the general population in both Western Europe and the United States. It is unknown whether preoperative angiography is still mandatory in all patients.
  
  
  OBJECTIVE
  To assess the prevalence of angiographically defined coronary artery disease in patients with aortic valve replacement and trends during a ten-year period.
  
  
  METHODS
  We performed a retrospective cross-sectional study of patients undergoing aortic valve replacement between 1988 and 1998 in our institution. Patients with a history of coronary artery disease and patients younger than 25 years were excluded. Coronary atherosclerosis was defined as one or more coronary artery luminal stenosis of 50% or more on preoperative coronary angiography.
  
  
  RESULTS
  During the study period 1339 patients had aortic valve replacement in our institution, data on 1322 (98%) were available for analysis. Previous coronary artery disease was documented in 124 patients (10%). After exclusion of 17 patients (no angiography), data on a total of 1181 patients were analysed. Coronary atherosclerosis was present in 472 patients (40%) on preoperative coronary angiography. Several well-known risk factors of ischaemic heart disease were associated with coronary atherosclerosis. The prevalence of angiographically defined coronary atherosclerosis varied between 30% and 50% per year. There was, however, no significant trend during the study period. Multivariate analyses, to adjust for potential differences in risk factors during the observation period, did not change this conclusion.
  
  
  CONCLUSIONS
  The prevalence of angiographically defined coronary artery disease in patients scheduled for aortic valve replacement is still high. From 1988 to 1998, no significant change was observed in angiographic measures of coronary atherosclerosis in patients with aortic valve replacement. Therefore, it is advised to perform coronary angiography before aortic valve surgery.
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: K
authors.initials: K
authors.lastname: Thomas
authors.forename: T H
authors.initials: TH
authors.lastname: Sie
authors.forename: M M P
authors.initials: MM
authors.lastname: Haalebos
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
keywords: angiography; aortic valve replacement; coronary heart disease; epidemiology