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Coronary risk stratification of patients undergoing surgery for valvular heart disease.

Abstract：

BACKGROUND: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. METHODS:The 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. RESULTS:The 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%. CONCLUSION:A 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.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Hasselbalch RB,Engstrøm T,Pries-Heje M,Heitmann M,Pedersen F,Schou M,Mickley H,Elming H,Steffensen R,Køber L,Iversen K

doi

10.1016/j.ijcard.2016.11.078

subject

Has Abstract

pub_date

2017-01-15 00:00:00

pages

37-42

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(16)33524-0

journal_volume

227

pub_type

杂志文章

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