PREOPERATIVE CORONARY ARTERIOGRAPHY IN PATIENTS WITH VALVULAR HEART-DISEASE - A PROBABILISTIC ANALYSIS OF CORONARY LESION

Introduction and objectives. The indication of preoperative coronary a ngiography is routinely performed for patients who are going to valve replacement surgery. The need of coronary angiography is based on age, gender and previous angina, but it is not usually based on risk facto rs. The purpose of this study has been to find markers to predict the probability of coronary lesion in this group of patients. Patients and methods. We studied retrospectively a population of 541 patients with valvular heart disease who underwent preoperative coronary angiograph y from 1989 to 1994. Mean age was 61.8 (range 34-82). There were 301 m en and 240 women. We analyzed in each patient different variables such as age, gender, previous angina, hypertension, diabetes mellitus, tob acco and famylial predisposition. We correlated these variables with t he presence of coronary lesion by multivariate analysis. Results. Ther e were 73 patients with coronary lesion greater than 50%. The prevalen ce of significant coronary artery disease was 13.4%. Angina was presen t in 34.6%. The risk of coronary lesion was defined as odds ratio: pre vious angina 3.3; tobacco 2.6; diabetes 2.2; hypertension 1.8 and age 1.4. The others variables were not predictor of coronary lesion. The p robability of coronary lesion in patients without those variables (ang ina, tobacco, diabetes, hypertension) was 4%. If we analyzed age, the probability of coronary lesion was 3% in patients under 65 years and 6 % above 65 years, Conclusions. The lack of previous angina and at leas t the three risk factors described as predictors of coronary lesion (h ypertension, tobacco and diabetes) can define a group of patients with a very low prevelence of coronary lesion, especially if they are unde r 65 years. It can allow us to avoid preoperatory coronary angiography in patients who undergo valve replacement.