eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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4/2019
vol. 15
 
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abstract:
Original paper

Acute coronary syndromes and atherosclerotic plaque burden distribution in coronary arteries among patients with valvular heart disease (BIA-WAD registry)

Łukasz Kuźma
1
,
Hanna Bachórzewska-Gajewska
1, 2
,
Marcin Kożuch
1
,
Krzysztof Struniawski
1
,
Szymon Pogorzelski
1
,
Tomasz Hirnle
3
,
Sławomir Dobrzycki
1

  1. Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
  2. Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
  3. Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland
Adv Interv Cardiol 2019; 15, 4 (58): 422–430
DOI: https://doi.org/10.5114/aic.2019.90216
Online publish date: 2019/12/08
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Introduction
Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy.

Aim
Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD.

Material and methods
Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days.

Results
Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% (n = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients (n = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% (n = 86), and prior ACS in 7.6% (n = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005–1.072; p = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370–11.065, p = 0.035) increased the mortality rate.

Conclusions
Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival.

keywords:

aortic stenosis, mitral insufficiency, coronary artery disease, myocardial infarction
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