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. 1982 Jan 23;284(6311):223–226. doi: 10.1136/bmj.284.6311.223

Preoperative prediction of significant coronary artery disease in patients with valvular heart disease.

D R Ramsdale, E B Faragher, D H Bennett, C L Bray, C Ward, D C Beton
PMCID: PMC1495791  PMID: 6799111

Abstract

A prognostic index for predicting significant coronary artery disease was established using multiple logistic regression analysis of clinical data from 643 patients with valvular heart disease who had undergone routine coronary arteriography before valve replacement. The index or equation obtained incorporated the presence of angina, a family history of ischaemic heart disease, age, cigarette smoking habits, mitral valve disease, sex, and electrocardiographic evidence of myocardial infarction. The equation was validated using prospective data from 387 patients with valvular disease and shown to enable almost a third of routine coronary arteriograms to be omitted while maintaining 95% sensitivity for patients with coronary artery disease. Similar analysis of the more detailed prospective data produced a second discriminant function incorporating diastolic blood pressure, total cigarettes smoked in life, the severity of angina, family history of ischaemic heart disease, age, current cigarette smoking habits, and the ratio of total to high density lipoprotein cholesterol. This method improved the discrimination between patients with and without coronary artery disease, allowing omission of 30% of routine coronary arteriograms with 100% sensitivity for patients with coronary disease and omission of 41% with a 96% sensitivity level.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson A. J., Barboriak J. J., Rimm A. A. Risk factors and angiographically determined coronary occlusion. Am J Epidemiol. 1978 Jan;107(1):8–14. doi: 10.1093/oxfordjournals.aje.a112511. [DOI] [PubMed] [Google Scholar]
  2. Barham D., Trinder P. An improved colour reagent for the determination of blood glucose by the oxidase system. Analyst. 1972 Feb;97(151):142–145. doi: 10.1039/an9729700142. [DOI] [PubMed] [Google Scholar]
  3. Basta L. L., Raines D., Najjar S., Kioschos J. M. Clinical, haemodynamic, and coronary angiographic correlates of angina pectoris in patients with severe aortic valve disease. Br Heart J. 1975 Feb;37(2):150–157. doi: 10.1136/hrt.37.2.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Baxter R. H., Reid J. M., McGuiness J. B., Stevenson J. G. Relation of angina to coronary artery disease in mitral and in aortic valve disease. Br Heart J. 1978 Aug;40(8):918–922. doi: 10.1136/hrt.40.8.918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bonchek L. I., Anderson R. P., Rösch J. Should coronary arteriography be performed routinely before valve replacement? Am J Cardiol. 1973 Apr;31(4):462–466. doi: 10.1016/0002-9149(73)90295-6. [DOI] [PubMed] [Google Scholar]
  6. Bourassa M. G., Noble J. Complication rate of coronary arteriography. A review of 5250 cases studied by a percutaneous femoral technique. Circulation. 1976 Jan;53(1):106–114. doi: 10.1161/01.cir.53.1.106. [DOI] [PubMed] [Google Scholar]
  7. Cramér K., Paulin S., Werkö L. Coronary angiographic findings in correlation with age, body weight, blood pressure, serum lipids, and smoking habits. Circulation. 1966 Jun;33(6):888–900. doi: 10.1161/01.cir.33.6.888. [DOI] [PubMed] [Google Scholar]
  8. Davis K., Kennedy J. W., Kemp H. G., Jr, Judkins M. P., Gosselin A. J., Killip T. Complications of coronary arteriography from the Collaborative Study of Coronary Artery Surgery (CASS). Circulation. 1979 Jun;59(6):1105–1112. doi: 10.1161/01.cir.59.6.1105. [DOI] [PubMed] [Google Scholar]
  9. Day N. E., Kerridge D. F. A general maximum likelihood discriminant. Biometrics. 1967 Jun;23(2):313–323. [PubMed] [Google Scholar]
  10. Dimsdale J. E., Hutter A. M., Jr, Gilbert J., Hackett T. P., Block P. C., Catanzano D. M. Predicting results of coronary angiography. Am Heart J. 1979 Sep;98(3):281–286. doi: 10.1016/0002-8703(79)90037-1. [DOI] [PubMed] [Google Scholar]
  11. Emanuel R. Editorial: Coronary ateriography. Br Heart J. 1975 Mar;37(3):229–230. doi: 10.1136/hrt.37.3.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Harris C. N., Kaplan M. A., Parker D. P., Dunne E. F., Cowell H. S., Ellestad M. H. Aortic stenosis, angina, and coronary artery disease. Interrelations. Br Heart J. 1975 Jun;37(6):656–661. doi: 10.1136/hrt.37.6.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hasin Y., Eisenberg S., Friedlander J., Lewis B. S., Gotsman M. S. Relationship between extent of coronary artery disease and correlative risk factors. Am Heart J. 1979 Nov;98(5):555–561. doi: 10.1016/0002-8703(79)90279-5. [DOI] [PubMed] [Google Scholar]
  14. Heiberg A. The heritability of serum lipoprotein and lipid concentrations. A twin study. Clin Genet. 1974;6(4):307–316. doi: 10.1111/j.1399-0004.1974.tb02091.x. [DOI] [PubMed] [Google Scholar]
  15. Judkins M. P. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967 Nov;89(5):815–824. doi: 10.1148/89.5.815. [DOI] [PubMed] [Google Scholar]
  16. Kannel W. B., Castelli W. P. Is the serum total cholesterol an anachronism? Lancet. 1979 Nov 3;2(8149):950–951. doi: 10.1016/s0140-6736(79)92638-2. [DOI] [PubMed] [Google Scholar]
  17. Kannel W. B., McGee D., Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol. 1976 Jul;38(1):46–51. doi: 10.1016/0002-9149(76)90061-8. [DOI] [PubMed] [Google Scholar]
  18. Lacy J., Goodin R., McMartin D., Masden R., Flowers N. Coronary atherosclerosis in valvular heart disease. Ann Thorac Surg. 1977 May;23(5):429–435. doi: 10.1016/s0003-4975(10)64162-8. [DOI] [PubMed] [Google Scholar]
  19. Linhart J. W., De la Torre A., Ramsey H. W., Wheat M. W., Jr The significance of coronary artery disease in aortic valve replacement. J Thorac Cardiovasc Surg. 1968 Jun;55(6):811–819. [PubMed] [Google Scholar]
  20. Lopes-Virella M. F., Stone P., Ellis S., Colwell J. A. Cholesterol determination in high-density lipoproteins separated by three different methods. Clin Chem. 1977 May;23(5):882–884. [PubMed] [Google Scholar]
  21. Miall W. E. Heredity and hypertension. Practitioner. 1971 Jul;207(237):20–27. [PubMed] [Google Scholar]
  22. Morrison G. W., Thomas R. D., Grimmer S. F., Silverton P. N., Smith D. R. Incidence of coronary artery disease in patients with valvular heart disease. Br Heart J. 1980 Dec;44(6):630–637. doi: 10.1136/hrt.44.6.630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Nupuf M. S., Sutherland W. H. High density lipoprotein levels in children of young men with ischaemic heart disease. Atherosclerosis. 1979 Jul;33(3):365–370. doi: 10.1016/0021-9150(79)90188-6. [DOI] [PubMed] [Google Scholar]
  24. Rafflenbeul W., Urthaler F., Lichtlen P., James T. N. Quantitative difference in "critical" stenosis between right and left coronary artery in man. Circulation. 1980 Dec;62(6):1188–1196. doi: 10.1161/01.cir.62.6.1188. [DOI] [PubMed] [Google Scholar]
  25. Ramsdale D. R., Bennett D. H., Bray C. L., Ward C., Beton D. C., Faragher E. B. Coronary arteriography prior to valve replacement. Eur Heart J. 1981 Feb;2(1):83–86. doi: 10.1093/oxfordjournals.eurheartj.a061167. [DOI] [PubMed] [Google Scholar]
  26. Richardson T. A modification of the Trinder AutoAnalyzer method for glucose. Ann Clin Biochem. 1977 Jul;14(4):223–226. doi: 10.1177/000456327701400160. [DOI] [PubMed] [Google Scholar]
  27. Rosenman R. H., Brand R. J., Jenkins D., Friedman M., Straus R., Wurm M. Coronary heart disease in Western Collaborative Group Study. Final follow-up experience of 8 1/2 years. JAMA. 1975 Aug 25;233(8):872–877. [PubMed] [Google Scholar]
  28. SCHAEFER L. E., ADLERSBERG D., STEINBERG A. G. Heredity, environment, and serum cholesterol; a study of 201 healthy families. Circulation. 1958 Apr;17(4 Pt 1):537–542. doi: 10.1161/01.cir.17.4.537. [DOI] [PubMed] [Google Scholar]
  29. SONES F. M., Jr, SHIREY E. K. Cine coronary arteriography. Mod Concepts Cardiovasc Dis. 1962 Jul;31:735–738. [PubMed] [Google Scholar]
  30. Salel A. F., Fong A., Zelis B. S., Miller R. R., Borhani N. O., Mason D. T. Accuracy of numerical coronary profile. Correlation of risk factors with arteriographically documented severity of atherosclerosis. N Engl J Med. 1977 Jun 23;296(25):1447–1450. doi: 10.1056/NEJM197706232962507. [DOI] [PubMed] [Google Scholar]
  31. Sharratt G. P., Rees P., Conway N. Myocardial infarction complicating aortic valve replacement. J Thorac Cardiovasc Surg. 1976 Jun;71(6):869–871. [PubMed] [Google Scholar]
  32. Swanton R. H., Brooksby I. A., Jenkins B. S., Coltart D. J., Webb-Peploe M. M., Williams B. T., Braimbridge M. V. Determinants of angina in aortic stenosis and the importance of coronary arteriography. Br Heart J. 1977 Dec;39(12):1347–1352. doi: 10.1136/hrt.39.12.1347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Tattersall R. B., Fajans S. S. A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. Diabetes. 1975 Jan;24(1):44–53. doi: 10.2337/diab.24.1.44. [DOI] [PubMed] [Google Scholar]
  34. Truett J., Cornfield J., Kannel W. A multivariate analysis of the risk of coronary heart disease in Framingham. J Chronic Dis. 1967 Jul;20(7):511–524. doi: 10.1016/0021-9681(67)90082-3. [DOI] [PubMed] [Google Scholar]
  35. Vlietstra R. E., Frye R. L., Kronmal R. A., Sim D. A., Tristani F. E., Killip T., 3rd Risk factors and angiographic coronary artery disease: a report from the coronary artery surgery study (CASS). Circulation. 1980 Aug;62(2):254–261. doi: 10.1161/01.cir.62.2.254. [DOI] [PubMed] [Google Scholar]
  36. Wilson P. W., Garrison R. J., Castelli W. P., Feinleib M., McNamara P. M., Kannel W. B. Prevalence of coronary heart disease in the Framingham Offspring Study: role of lipoprotein cholesterols. Am J Cardiol. 1980 Oct;46(4):649–654. doi: 10.1016/0002-9149(80)90516-0. [DOI] [PubMed] [Google Scholar]
  37. Zir L. M., Dinsmore R. E., Goss C., Harthorne J. W. Experience with preformed catheters for coronary angiography by the brachial approach. Cathet Cardiovasc Diagn. 1975;1(3):303–310. doi: 10.1002/ccd.1810010309. [DOI] [PubMed] [Google Scholar]

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