[Prevalence of Coronary Artery Disease in Patients with Rheumatic Heart Disease in China]

Objective: To investigate the prevalence of coronary artery disease (CAD) and the atherosclerotic risk factors in the patients undergoing valvular surgery due to rheumatic heart disease.

Methods: Consecutive 651 patients with rheumatic heart disease aged > 40 who were scheduled for valve surgery underwent diagnostic coronary angiography to delineate coronary arteries. Significant coronary artery disease was considered to be present if one or more single coronary branches showed 50% or more luminal stenosis. Symptoms, such chest pain, were evaluated. Established risk factors for CAD, such as diabetes mellitus, systemic hypertension, smoking, and dyslipidemia were evaluated. Previous history of myocardial infarction and coronary artery bypass surgery was also recorded.

Results: Seventy-one patients (10.91%), 54 males and 17 females, were detected as with CAD. The mean age of the patients with CAD was (63 +/- 9), significantly higher than that of the patients with normal coronary arteries [(54 +/- 9), P < 0.01]. The atheromatous lesion mostly involved the left descending branch (38.12%), and 38 patients (53.52%) showed lesions in 2 or more branches. The prevalence rates of diabetes mellitus and hypertension in the CAD group were 32.39% and 29.58% respectively, both significantly higher than those in the non-CAD group (7.41% and 19.48% respectively; P < 0.01 and P = 0.047). The smoking rate of the CAD group was 36.62%, significantly higher than that of the non-CAD group (12.93%; P < 0.01). However, there were not significant differences in the prevalence rates of dyslipidemia and ECG ST-T changes between these 2 groups (both P > 0.05). No relation was found between the rheumatic disease and coronary disease distribution (P > 0.05).

Conclusion: Coronary angiography should be performed in all patients clinically suspected with CAD, aged > 50 and the patients with angina and/or coronary risk factors in order to decrease the occurrence of operative complications.