FREQUENCY OF ANGIOGRAPHICALLY SIGNIFICANT DISEASE IN PATIENTS UNDERGOING VALVE REPLACEMENT SURGERY WITH OR WITHOUT RISK FACTORS FOR ATHEROSCLEROSIS

Abstract

Background: Coronary artery disease (CAD) often coexists with valvular heart disease, especially in regions with high prevalence of rheumatic etiology. In developing countries like Pakistan, the clinical presentation of valvular pathology differs significantly from the West, with mitral valve involvement being more common. While CAD screening is routine in developed settings, data on its prevalence in patients undergoing valve replacement surgery in low- to middle-income populations remain scarce, highlighting the need for localized evidence to guide preoperative protocols.

Objective: To determine the frequency of angiographically significant CAD in patients undergoing valve replacement surgery and compare its prevalence among patients with and without traditional atherosclerotic risk factors.

Methods: This descriptive cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, over six months. A total of 266 patients aged 40–60 years undergoing aortic, mitral, or double valve replacement surgery were enrolled through consecutive non-probability sampling. Patients with prior CAD, valve surgery, CABG, or PCI were excluded. Detailed history, BMI, socioeconomic data, and risk factor profiles were recorded. Coronary angiography was performed in all patients to identify >70% stenosis in major arteries. Data were analyzed using SPSS v25; associations were tested using chi-square or Fisher’s exact test with a p-value <0.05 as significant.

Results: Among 266 participants, 157 (59.0%) were male and 176 (66.2%) resided in urban areas. Mitral valve replacement was the most common procedure (57.5%). Risk factors for atherosclerosis were present in 176 (66.2%) patients. Angiographically significant CAD was identified in 123 (46.2%) patients, with higher prevalence among those with risk factors.

Conclusion: The study highlights a high burden of silent but significant CAD in patients undergoing valve replacement, warranting routine coronary evaluation regardless of overt risk factor presence.