Impact of coronary artery disease on in-hospital mortality in patients with aortic valve disease
Tóm tắt
Although aortic valve disease (AVD) is frequently associated with coronary artery disease (CAD), little is known about the impact of significant coronary artery disease on mortality after diagnostic cardiac catheterization in patients with AVD. We analyzed data of the coronary angiography registry of the “Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte” (ALKK) in Germany. The primary endpoint was in-hospital mortality. A total of 1427 consecutive patients with AVD (438 patients with CAD versus 989 patients without CAD) underwent diagnostic catheterization in 2006 in 42 hospitals. All cause in-hospital mortality was more than threefold higher in patients with CAD (16/438; 3.7%) as compared to patients without CAD (12/989; 1.2%; p < 0.01; OR 3.09, 95% CI 1.45–6.58). Even after adjustment for age, sex, presence of diabetes mellitus and renal insufficiency, in-hospital all cause mortality remained statistically significant different between the two groups (OR 2.4; 95% CI 1.09–5.28; p < 0.01). Several factors, such as transient ischemic attack/stroke, volume of contrast agent, and left heart catheter-associated complications could not be identified as possible causes for the increase in mortality. This analysis in patients with the leading diagnosis of AVD shows a significantly higher in-hospital mortality after diagnostic cardiac catheterization in case of an accompanying CAD. However, further studies are necessary to identify the driving force for the increase in mortality.
Tài liệu tham khảo
Stewart BF, Siscovick D, Lind BK et al (1997) Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 29:630–634
Otto CM, Lind BK, Kitzman DW et al (1999) Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147
Soler-Soler J, Galve E (2000) Worldwide perspective of valve disease. Heart 83:721–725
Iung B, Baron G, Butchart EG et al (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 24:1231–1243
Rajamannan NM, Gersh B, Bonow RO (2003) Calcific aortic stenosis: from bench to the bedside—emerging clinical and cellular concepts. Heart 89:801–805
Vahanian A, Baumgartner H, Bax J et al (2007) Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European society of cardiology. Eur Heart J 28:230–268
Vogt A, Bonzel T, Harmjanz D, Leitner ER von et al (1997) PTCA registry of German community hospitals. Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte (ALKK) Study Group. Eur Heart J 18:1110–1114
Zeymer U, Zahn R, Hochadel M et al (2005) Indications and complications of invasive diagnostic procedures and percutaneous coronary interventions in the year 2003. Results of the quality control registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Z Kardiol 94:392–398
Bermudez GA, Abdelnur R, Midell A, DeMeester T (1983) Coronary artery disease in aortic stenosis: importance of coronary arteriography and surgical implications. Angiology 34:591–596
Bhakhri K, Teoh K, Yap J (2012) Preoperative investigations in adult cardiac surgery patients. Surgery 30:9–12