Coronary risk stratification of patients undergoing surgery for valvular heart disease

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• 作者：Rasmus Bo Hasselbalch^a ; ^{r.hasselbalch@gmail.com} ; Thomas Engstr&oslash ; m^b ; Mia Pries-Heje^a ; Merete Heitmann^c ; Frants Pedersen^b ; Morten Schou^a ; Hans Mickley^d ; Hanne Elming^e ; Rolf Steffensen^f ; Lars K&oslash ; ber^b ; Kasper Iversen^a
• 关键词：Multislice computed tomography ; Coronary angiography ; Valvular heart disease ; Coronary artery disease
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：37-42
• 全文大小：464 K
• 卷排序：227

文摘

Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG.MethodsThe study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry.ResultsThe study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction < 30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%.ConclusionA score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery.