Significant coronary artery disease was present in 45.7% of valvular disease patients with angina versus 19.2% without angina (P<0.001), but prevalence was only 3% when both were absent.
Observational (n=387)
Does the absence of angina and coronary risk factors reliably exclude significant coronary artery disease in patients undergoing valve replacement?
Preoperative coronary arteriography might be safely omitted in patients undergoing valve replacement who have neither angina nor coronary risk factors due to a very low prevalence of significant coronary artery disease.
Absolute Event Rate: 45.7% vs 19.2%
p-value: p=<0.001
The relationship between coronary risk factors and coronary artery disease in patients with valvular heart disease was studied prospectively in 387 consecutive patients undergoing routine coronary arteriography prior to valve replacement. Coronary artery disease was as common in patients with mitral valve disease (31.9%) as in those with aortic valve disease (26.8%). Although it occurs more frequently in patients with angina (45.7%) significant coronary artery disease is found in 19.2% (47 of 245) of those without angina (P less than 0.001), suggesting that the presence of angina alone is an unreliable indicator of significant coronary disease. The prevalence and severity of significant coronary artery disease increases progressively as the number of coronary risk factors also increase (P less than 0.001) but the prevalence is low (3%) in patients in whom both angina and coronary risk factors are absent. These findings suggest that preoperative coronary arteriography might be omitted in this latter group of patients.
Ramsdale et al. (Sat,) conducted a observational in Valvular heart disease (n=387). Angina and coronary risk factors vs. Absence of angina and coronary risk factors was evaluated on Significant coronary artery disease (p=<0.001). Significant coronary artery disease was present in 45.7% of valvular disease patients with angina versus 19.2% without angina (P<0.001), but prevalence was only 3% when both were absent.