Key result
Angina pectoris in severe aortic regurgitation is linked to a ~3-fold higher CAD risk.
Why the study?
The prevalence of angiographically significant CAD and its relation to angina pectoris in patients with isolated, severe aortic regurgitation was unclear.
Does the presence of angina pectoris predict angiographically significant coronary artery disease in patients with isolated, severe aortic regurgitation?
Observational (n=78)
Does the presence of angina pectoris predict angiographically significant coronary artery disease in patients with isolated, severe aortic regurgitation?
Relative Risk: 3
Absolute Event Rate: 58% vs 19%
Angina pectoris is a moderate predictor of significant coronary artery disease in patients with severe aortic regurgitation, supporting the recommendation for routine coronary angiography before aortic valve replacement in patients over 40.
Seventy-eight patients with isolated, severe aortic regurgitation (AR) were studied retrospectively to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris (AP). Angiographically, significant CAD was present in 29 of 78 patients (37%), and 36 patients (46%) had AP. Twenty-one of 36 patients (58%) with AP and 8 of 42 patients (19%) without AP had angiographically significant CAD. AP as a predictor of significant CAD had a sensitivity of 73%, specificity of 69% and a risk ratio of 3:1. The predictive accuracy of detecting CAD in the absence of AP was 81%. The benefit from concomitant coronary artery bypass grafting at the time of aortic valve replacement for AR has not been clearly demonstrated; therefore, routine coronary angiography is still recommended for all AR patients older than 40 years undergoing aortic valve replacement.
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Pathak et al. (1986) conducted an observational in Isolated, severe aortic regurgitation (n=78). Angina pectoris vs. Absence of angina pectoris was evaluated on Angiographically significant coronary artery disease (risk ratio 3:1). Angina pectoris in patients with severe aortic regurgitation predicted significant coronary artery disease (58% vs 19% without angina; risk ratio 3:1).
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