Objective: To determine the prevalence of CAD detectable by angiography and its relation to angina pectoris and coronary risk factors in patients with severe AS.
Patients and Methods: All patients with symptomatic AS who had undergone aortic valve replacement and preoperative cardiac catheterisation at the Austin and Repatriation Medical Centre between 1 January 1986 and 31 May 1996 were retrospectively analysed. Those patients with multiple valve disease, aortic regurgitation of grade 2 or more in severity, or who had had prior coronary artery or valve surgery were excluded from this analysis.
Results: A total of 328 consecutive patients with severe AS (242 men and 86 women; mean age 72 years, range 39–84 years) were studied. Significant CAD (reduction in luminal diameter ≥50 % ) was found in 162 patients (49.4 % ). Typical angina was present in 74.7 % of these 162 patients but it was also found in 44.6 % of the 166 patients without obstructive CAD. Of the patients without angina (n = 133), 30.8 % had significant CAD. By multivariate logistic regression, we have identified seven significant predictors for CAD among severe AS patients. Five factors increased risk. Expressed as odds ratio with 95 % confidence interval, these included: (i) age in years (1.07; 1.04–1.11, P = 0.001); (ii) male gender (2.09; 1.14–3.80, P = 0.016); (iii) angina pectoris (3.19; 1.89–5.37, P < 0.001); (iv) history of myocardial infarction (2.87; 1.38–5.97, P = 0.005); and (v) peripheral vascular disease (2.28; 1.28–4.05, P = 0.005). Factors associated with decreased likelihood of CAD were serum high density lipoprotein (HDL) cholesterol (0.58; 0.34–0.71, P = 0.002) and peak systolic gradient across the aortic valve (0.97; 0.95–0.99, P = 0.0113).
Conclusion: Coronary arteriography can probably be omitted for a patient with severe AS if that patient has no symptoms of angina and has no risk factors known to increase its incidence.