Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery
Abstract Background: The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients wi...
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Sociedade Brasileira de Cardiologia (SBC)
2017-09-01
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doaj-91ba309ad01840878697882975ab82312020-11-25T01:51:51ZengSociedade Brasileira de Cardiologia (SBC)Arquivos Brasileiros de Cardiologia1678-41702017-09-01109434835610.5935/abc.20170135S0066-782X2017001300348Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve SurgeryJosé Guilherme CazelliGabriel Cordeiro CamargoDany David KruczanClara WekslerAlexandre Rouge FelipeIlan GottliebAbstract Background: The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. Objectives: To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Methods: Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Conclusions: Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017001300348&lng=en&tlng=enDoença Arterial CoronarianaDoenças das Valvas CardíacasAngiografia Coronariana InvasivaAngiografia por Tomografia Computadorizada |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
José Guilherme Cazelli Gabriel Cordeiro Camargo Dany David Kruczan Clara Weksler Alexandre Rouge Felipe Ilan Gottlieb |
spellingShingle |
José Guilherme Cazelli Gabriel Cordeiro Camargo Dany David Kruczan Clara Weksler Alexandre Rouge Felipe Ilan Gottlieb Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery Arquivos Brasileiros de Cardiologia Doença Arterial Coronariana Doenças das Valvas Cardíacas Angiografia Coronariana Invasiva Angiografia por Tomografia Computadorizada |
author_facet |
José Guilherme Cazelli Gabriel Cordeiro Camargo Dany David Kruczan Clara Weksler Alexandre Rouge Felipe Ilan Gottlieb |
author_sort |
José Guilherme Cazelli |
title |
Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery |
title_short |
Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery |
title_full |
Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery |
title_fullStr |
Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery |
title_full_unstemmed |
Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery |
title_sort |
prevalence and prediction of obstructive coronary artery disease in patients undergoing primary heart valve surgery |
publisher |
Sociedade Brasileira de Cardiologia (SBC) |
series |
Arquivos Brasileiros de Cardiologia |
issn |
1678-4170 |
publishDate |
2017-09-01 |
description |
Abstract Background: The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. Objectives: To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Methods: Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Conclusions: Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease. |
topic |
Doença Arterial Coronariana Doenças das Valvas Cardíacas Angiografia Coronariana Invasiva Angiografia por Tomografia Computadorizada |
url |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017001300348&lng=en&tlng=en |
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