Prevalence of Angiographically Significant Coronary Artery Disease in Patients Undergoing Surgery for Rheumatic Valvular Heart Disease.

Abstract

Background: Coronary artery disease (CAD) may coexist with rheumatic valvular heart disease and can influence perioperative planning and surgical management. This study aimed to determine the prevalence of angiographically significant CAD among patients aged 40 years and above undergoing valve replacement surgery for rheumatic valvular heart disease.

Methodology: This descriptive cross-sectional study was conducted at the Medical Teaching Institution, Lady Reading Hospital, Peshawar, from January 2020 to December 2024. Male and female patients aged ≥40 years requiring valve replacement for rheumatic valvular heart disease were enrolled through consecutive non-probability sampling. Valvular disease was assessed by transthoracic echocardiography. Patients with previously documented CAD, prior coronary revascularization, degenerative valvular disease, infective endocarditis, bicuspid aortic valve, or emergency surgery were excluded. All participants underwent preoperative coronary angiography. Significant CAD was defined as >50% stenosis of the left main coronary artery or >70% stenosis of other major coronary arteries. Although the minimum calculated sample size was 151, 215 eligible patients were included.

Results: Of 215 patients, 121 (56.3%) were male and 94 (43.7%) female, with a mean age of 48.84 ± 6.62 years. Significant CAD was detected in 37 (17.20%) patients. Among these, 13 (35.10%) had single-vessel, 16 (43.20%) double-vessel, and 8 (21.60%) triple-vessel disease; 24 (64.9%) had multivessel disease.

Conclusion: Significant CAD was present in 17.20% of patients undergoing valve replacement for rheumatic valvular disease, with nearly two-thirds demonstrating multivessel involvement, supporting careful preoperative coronary assessment for appropriate surgical planning.