title: Coronary risk stratification of patients undergoing surgery for valvular heart disease.
abstract: BACKGROUND
  Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG.
  
  
  METHODS
  The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry.
  
  
  RESULTS
  The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%.
  
  
  CONCLUSIONS
  A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery.
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark. Electronic address: r.hasselbalch@gmail.com.
authors.forename: Rasmus Bo
authors.initials: RB
authors.lastname: Hasselbalch
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Mia
authors.initials: M
authors.lastname: Pries-Heje
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Heitmann
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
authors.affiliation: Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark.
authors.forename: Hanne
authors.initials: H
authors.lastname: Elming
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark.
authors.forename: Rolf
authors.initials: R
authors.lastname: Steffensen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Iversen
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000639:trends*; D012042:Registries; D012307:Risk Factors
keywords: Coronary angiography; Coronary artery disease; Multislice computed tomography; Valvular heart disease