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The Journal of Cardiovascular Surgery 2022 October;63(5):614-23

DOI: 10.23736/S0021-9509.22.12306-2


lingua: Inglese

Contemporary prevalence of coronary artery disease in patients referred for heart valve surgery

João FERREIRA REIS 1 , Tiago MENDONÇA 1, Christopher STRONG 2, David ROQUE 3, Pedro D. MODAS 1, Carlos MORAIS 3, Miguel MENDES 2, Rui CRUZ FERREIRA 1, Sérgio B. BAPTISTA 3, 4, Luís RAPOSO 2, Rúben RAMOS 1

1 Department of Cardiology, Central Lisbon University Hospital Center, Hospital of Santa Marta, Lisbon, Portugal; 2 Department of Cardiology, Centro Hospitalar de Lisboa Ocidental (CHLO), Hospital of Santa Cruz, Carnaxide, Portugal; 3 Department of Cardiology, Hospital Prof. Doutor Fernando da Fonseca (HFF), EPE, Amadora, Portugal; 4 Faculty of Medicine, University Clinic of Cardiology, University of Lisbon, Lisbon, Portugal

BACKGROUND: Patients undergoing heart valve surgery are routinely evaluated for the presence of coronary artery disease (CAD). Currently, concomitant valve intervention and surgical revascularization is recommended when there is obstructive CAD. The aim of our study was to evaluate the prevalence of CAD, its treatment strategies, and their prognostic implications in a contemporary population of patients with valvular heart disease (VHD) referred for valve surgery (HVS).
METHODS: In a multicenter registry, consecutive patients with formal indication for HVS referred for a preoperative routine invasive coronary angiogram (ICA) were analyzed. Baseline characteristics, CAD prevalence and revascularization patterns, as well as their impact on short and mid-term all-cause mortality, were assessed.
RESULTS: Overall, 1133 patients were included; most had aortic stenosis (69%) and obstructive CAD was present in 307 (27.1%). HVS was ultimately performed in 82.3%. In patients with CAD, 53.4% were revascularized. After a mean follow-up time of 29.06±18.46 months, all-cause mortality rate was 12.9%. In multivariate analysis, not having HVS (HR 6.845, 95% CI=4.281-10.947, P<0.001), obstructive CAD (HR 2.762, 95% CI=1.764-4.326, P<0.01), COPD (HR 2.043, 95% CI=1.014-4.197, P=0.022), and age (HR 1.030, 95% CI=1.009-1.063, P=0.047), were independent predictors of all-cause mortality. In patients with obstructive CAD who underwent HVS, revascularization was not significantly associated with survival (HR 2.127, 95% CI=0.0-4.494, P=0.048; log rank P=0.042).
CONCLUSIONS: In a contemporary cohort of patients with VHD and surgical indication, overall obstructive CAD prevalence was 27%. CAD presence and severity were associated with higher mortality. However, revascularization was not associated with a survival benefit, except in patients with left anterior descending artery disease.

KEY WORDS: Valvular heart diseases; Heart valves; Surgical procedures, operative; Coronary artery disease; Coronary angiography

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