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Chirurgia 2013 April;26(2):85-92

language: English

Prevalence and risk factor of significant coronary artery disease in patients with rheumatic heart disease undergoing prosthesis replacement

Li B., Tan M., Yan T., Zhang G., Lu F., Wang C., Li L., Han L., Xu Z.

Department of Cardiothoracic Surgery, Changhai Hospital Second Military Medical University, Shanghai, P. R. China


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Aim: The aim of this paper was to investigate the prevalence of significant coronary artery disease (CAD) in Chinese patients with rheumatic heart disease (RHD) who need valve replacement and to evaluate the relationship between risk factors and the presence of significant CAD in these patients.
Methods: A total of 3082 patients with rheumatic valvular disease who were scheduled for heart valve surgery received coronary angiography. Risk factors for significant CAD (stenosis >50% in at least one major coronary artery) were evaluated according to the criteria in the Framingham study. Univariable and multivariable analysis were used to determine risk factors.
Results: Eight and a half percent (262/3082) of the RHD patients had angiographically diagnosed significant CAD. In the multivariable model, aortic stenosis without regurgitation (OR= 8.20, P<0.001) or with regurgitation (OR=2.69, P<0.001), hypertension (OR=6.41, P<0.001), and the male sex (OR=4.28, P<0.001) were the strongest risk factors for significant CAD. Elevation of serum ICAM-1 (OR=1.003, P=0.02) and vWF (OR=1.009, P=0.021) also showed weak but significant association with significant CAD.
Conclusion: Coronary angiography before surgical intervention for RHD should be considered for patients with risk factors associated with significant CAD, especially male patients more than 50 years old. Except gender and age, hypertension, diabetes mellitus, high level of serum s-ICAM-1 and vWF, and aortic valve lesion in RHD patients are adverse risk factors for significant CAD.

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