Narang Rajiv, Chadha Davinder S, Goel Kashish, Mishra Sandeep, Bajaj Naveen, Sharma Sanjeev, Gupta Nidhi, Bahl Vinay K
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
J Heart Valve Dis. 2009 Jul;18(4):455-60.
The role of screening coronary angiography in Asian Indian patients with rheumatic heart disease (RHD) due to undergo valve replacement surgery is unclear. Hence, the study aim was to determine the prevalence of coronary artery disease (CAD), and to monitor its correlation with demographic variables and valvular lesion type, in this patient group.
A retrospective analysis of 2,188 consecutive patients (1,319 men, 869 women; mean age 48 +/- 7 years) with rheumatic valvular heart disease was conducted. The patients underwent preoperative coronary angiography in a tertiary care hospital between 1991 and 2004.
The overall prevalence of CAD was 11% (12% in men, 8% in women). The prevalence of CAD in the age groups of 40-44, 45-49, 50-54, 55-59 and > 60 years was 4%, 5%, 9%, 15% and 20% in men, and 2%, 2%, 3%, 7% and 10% in women, respectively. Both, age and male gender were independently associated with the occurrence of CAD (p < 0.01). The unadjusted odds ratio of having CAD was highest in patients with aortic stenosis (2.08; p < 0.01), and lowest in those with aortic regurgitation (AR) (0.58; p = 0.018). Those patients with AR also showed an independent inverse association with the occurrence of CAD (p = 0.006).
The overall prevalence of CAD among Asian Indian patients with RHD was lower than that in patients from western countries. The cut-off age to perform coronary angiographic screening should be maintained at 40 years for men, and 55 years for women. The prevalence of CAD may be lower in those patients with AR.
对于因风湿性心脏病（RHD）而即将接受瓣膜置换手术的亚洲印度裔患者，冠状动脉造影筛查的作用尚不清楚。因此，本研究旨在确定该患者群体中冠状动脉疾病（CAD）的患病率，并监测其与人口统计学变量及瓣膜病变类型的相关性。
对2188例连续性风湿性心脏瓣膜病患者（1319例男性，869例女性；平均年龄48±7岁）进行回顾性分析。这些患者于1991年至2004年间在一家三级医疗中心接受了术前冠状动脉造影检查。
CAD的总体患病率为11%（男性为12%，女性为8%）。在40 - 44岁、45 - 49岁、50 - 54岁、55 - 59岁及60岁以上年龄组中，男性CAD患病率分别为4%、5%、9%、15%和20%，女性分别为2%、2%、3%、7%和10%。年龄和男性性别均与CAD的发生独立相关（p < 0.01）。未经调整的患CAD的比值比在主动脉瓣狭窄患者中最高（2.08；p < 0.01），在主动脉瓣反流（AR）患者中最低（0.58；p = 0.018）。AR患者也显示出与CAD发生的独立负相关（p = 0.006）。
亚洲印度裔RHD患者中CAD的总体患病率低于西方国家患者。男性进行冠状动脉造影筛查的临界年龄应维持在40岁，女性为55岁。AR患者中CAD的患病率可能较低。
