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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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Prevalence of concomitant obstructive coronary artery disease in a contemporary population of patients with surgical valvular heart disease
Session:
Posters 4 - Écran 6 - Miscelânea
Speaker:
David Cabrita Roque
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Posters
FP Number:
---
Authors:
David Cabrita Roque; Sérgio Bravo Baptista; Paulo Leal; Miguel Santos; Pedro Magno; José Loureiro; Luis Martins Brízida; Pedro Abreu; Carlos Sequeira De Morais
Abstract
<p><strong>INTRODUCTION: </strong>Invasive coronary angiography (ICA) is recommended in many patients with valvular heart disease (VHD) requiring surgery. These recommendations are based on outdated epidemiological data and the actual prevalence of significant coronary artery disease (CAD) may be overestimated.</p> <p><strong>OBJETIVE:</strong> Determine the prevalence and predictors of obstructive CAD in patients with severe valvular heart disease.</p> <p><strong>METHODS: </strong>In a single center retrospective study, all consecutive patients submitted to ICA prior to valvular surgery, between April 2015 and February 2017, were selected. Patients undergoing percutaneous valve intervention were excluded. Obstructive CAD was defined as 50% stenosis in a major epicardial vessel. Bivariate regression analysis was used to determine predictors of obstructive CAD.</p> <p><strong>RESULTS: </strong>192 consecutive patients were included in the analysis (mean age 73.1±10.7 years old; 51.6% male gender and median Euroscore II 2.41 [IQR 2.57]). The majority had severe aortic stenosis (AS) (64.6%), followed by severe mitral regurgitation (10.9%) and less prevalent forms of VHD (5.2% with severe mitral stenosis, 3.6% with severe aortic regurgitation and 0.5% with severe tricuspid regurgitation). The overall prevalence of any obstructive CAD in this heterogeneous population was 48.4%, but only 28.6% had significant (>50%) lesions. Multivariate predictors of obstructive CAD were age (OR 1.069; 95%CI 1.024-1.117, p=0.002), male gender (OR 2.285, 95%CI 1.105-4.725, p=0.026), diabetes (OR 2.273, 95%CI 1.107-5.666, p=0.025) and dyslipidemia (OR 2.388, 95% CI 1.112-5.128, p=0.026), with a trend for current smoking habits (OR 3.368, 95%CI 0.951-11.931, p=0.06). Hypertension and severe AS were not independent predictors of obstructive CAD in this population. In patients without any traditional risk factors, the prevalence of significant CAD was only 7.1%. In patients <60 years and in non-diabetic patients <70 years, the prevalence of significant CAD was only 10.7% and 11.6%, respectively.</p> <p><strong>CONCLUSIONS: </strong>The prevalence of CAD was lower than expected in this contemporary cohort of patients with VHD undergoing surgery. The main predictors of obstructive CAD were age, gender, diabetes and dyslipidemia. In younger patients, particularly those without risk factors, prevalence of CAD was particularly low. In these low risk patients, non-invasive evaluation of CAD by coronary CT-Scan may be an alternative.</p>
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