PMID- 25972053
OWN - NLM
STAT- MEDLINE
DCOM- 20150825
LR  - 20150619
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 116
IP  - 2
DP  - 2015 Jul 15
TI  - Prevalence and prediction of obstructive coronary artery disease in patients 
      referred for valvular heart surgery.
PG  - 280-5
LID - S0002-9149(15)01121-2 [pii]
LID - 10.1016/j.amjcard.2015.03.063 [doi]
AB  - Current guidelines recommend a coronary evaluation before valvular heart surgery 
      (VHS). Diagnostic coronary angiography is recommended in patients with known 
      coronary artery disease (CAD) and those with high pretest probability of CAD. In 
      patients with low or intermediate pretest probability of CAD, the guidelines 
      recommend coronary computed tomographic angiography. However, there are no tools 
      available to objectively assess a patient's risk for obstructive CAD before VHS. 
      To address this deficit, 5,360 patients without histories of CAD who underwent 
      diagnostic coronary angiography as part of preoperative evaluation for VHS were 
      identified. Obstructive CAD was defined as >/=50% stenosis in >/=1 artery. Of the 
      patients assessed, 1,035 (19.3%) were found to have obstructive CAD. Through 
      multivariate analysis, age, gender, diabetes, renal dysfunction, hyperlipidemia, 
      and a family history of premature CAD were found to be associated with the 
      presence of obstructive CAD (p <0.001 for all). After adjustment, the specific 
      dysfunctional valve was not associated with the presence of obstructive CAD. 
      Patients were then randomly split into derivation and validation cohorts. Within 
      the derivation cohort, using only age, gender, and the presence or absence of 
      risk factors, a model was constructed to predict the risk for obstructive CAD (C 
      statistic 0.766, 95% confidence interval 0.750 to 0.783). The risk prediction 
      model performed well within the validation cohort (C statistic 0.767, 95% 
      confidence interval 0.751 to 0.784, optimism 0.004). The bias-corrected C 
      statistic for the model was 0.765 (95% confidence interval 0.748 to 0.782). In 
      conclusion, this novel risk prediction tool can be used to objectively 
      risk-stratify patients who undergo preoperative evaluation before VHS and to 
      facilitate appropriate triage to computed tomographic angiography or diagnostic 
      coronary angiography.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Lappe, Jason M
AU  - Lappe JM
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Grodin, Justin L
AU  - Grodin JL
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Wu, Yuping
AU  - Wu Y
AD  - Department of Mathematics, Cleveland State University, Cleveland, Ohio.
FAU - Bott-Silverman, Corinne
AU  - Bott-Silverman C
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Cho, Leslie
AU  - Cho L
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic 
      address: chol@ccf.org.
LA  - eng
PT  - Journal Article
DEP - 20150418
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Coronary Angiography
MH  - Coronary Occlusion/complications/diagnosis/*epidemiology
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/complications/*surgery
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ohio/epidemiology
MH  - Prevalence
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Tomography, X-Ray Computed
EDAT- 2015/05/15 06:00
MHDA- 2015/08/26 06:00
CRDT- 2015/05/15 06:00
PHST- 2015/02/13 00:00 [received]
PHST- 2015/03/31 00:00 [revised]
PHST- 2015/03/31 00:00 [accepted]
PHST- 2015/05/15 06:00 [entrez]
PHST- 2015/05/15 06:00 [pubmed]
PHST- 2015/08/26 06:00 [medline]
AID - S0002-9149(15)01121-2 [pii]
AID - 10.1016/j.amjcard.2015.03.063 [doi]
PST - ppublish
SO  - Am J Cardiol. 2015 Jul 15;116(2):280-5. doi: 10.1016/j.amjcard.2015.03.063. Epub 
      2015 Apr 18.