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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Contemporary coronary artery disease prevalence in a valvular heart disease population undergoing surgery
Session:
Painel 9 -Doença Valvular 3
Speaker:
Tiago Mendonça
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Tiago Mendonça; Christopher Strong; David Cabrita Roque; Luís Almeida Morais; João Pedro Reis; Pedro Modas Daniel; Pedro Farto e Abreu; Manuel Almeida; Duarte Cacela; Carlos Sequeira De Morais; Miguel Mendes; Rui Cruz Ferreira; Sérgio Bravo Baptista; Luís Raposo ; Ruben Ramos
Abstract
<p><strong>Background</strong>: Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Older studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently.</p> <p><strong>Objectives: </strong>The goal of this study is to evaluate the baseline characteristics, prevalence of CAD and treatment strategies in a contemporary population with valvular heart disease (VHD) referred for valve surgery.</p> <p><strong>Methods: </strong>In a national multicentre registry, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine invasive coronary angiogram (ICA) were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70% (≥ 50% for left main artery). The prognostic impact of the different valve disease and CAD treatment strategies were assessed.</p> <p><strong>Results</strong>: 1175 patients (mean age 72.5 ± 10.1; male 49.2%) were referred for pre-operative ICA. Valvular disease prevalence was: aortic stenosis (66.7%), aortic regurgitation (6.6%), mitral stenosis (6%), mitral regurgitation (19.2%), tricuspid regurgitation (7.5%). Multivalvular disease was present in 7.1 %. Follow-up time was 29.06 ± 18.46 months. Prevalence of comorbidities was: Diabetes Mellitus (DM) 26%, chronic obstructive pulmonary disease (COPD) 5.7% and chronic kidney disease (CKD) 23.4%. Mean Euroscore II was 2.6%. Obstructive CAD was present in 27.3% patients. Mean Syntax score was 10.2 (< 22 in 88%, 23-32 in 10.2% and > 33 in 1.8%). Left main artery and 3-vessel disease were found in 13.1% and 11.8% of patients with CAD, respectively. Valvular surgery was ultimately performed in 80.3%. In patients with CAD, 57.3% were revascularized. All-cause mortality rate during follow-up was 12.9%, with 7.8% from cardiovascular causes. In univariate analysis DM, COPD, CKD, NYHA class, obstructive CAD and no surgery (p<0.05) were associated with mortality on follow up. In multivariate analysis obstructive CAD (OR 2.36, 95% CI 1.53-3.65, p<0.01) and no surgery (OR 6.05, 95% CI 3.95-9.30, p<0.01) persisted as independent all-cause mortality predictors. </p> <p><strong>Conclusion</strong>: In a contemporary cohort of patients with VHD and surgical indication, CAD prevalence is lower (27.3%) than described in literature. Mortality rates were higher in patients with obstructive CAD and in those who never underwent surgery. </p>
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