Coronary Artery Disease among Patients Undergoing Valve Replacement Surgery: A Retrospective Study of Angiographic Profiles and Predictors at a Southern Indian Tertiary Care Centre

Abstract

Introduction: Coronary Artery Disease (CAD) frequently co-exists with Valvular Heart Disease (VHD). In developing countries like India, the shifting epidemiology from rheumatic to degenerative VHD alters this association. Concomitant CAD drastically dictates surgical strategies, yet local angiographic profile data remains scarce. Aim: To determine the angiographic profile and clinical predictors of CAD in patients undergoing Coronary Angiography (CAG) prior to valve replacement surgery at an Indian tertiary care centre. Materials and Methods: The present retrospective study was conducted at Sree Mookambika Institute of Medical Sciences, Kanyakumari, Tamil Nadu, South India, and analysed data of 200 consecutive patients undergoing preoperative CAG before valve replacement surgery. Demographic profiles, cardiovascular risk factors, echocardiographic parameters, and angiographic findings were reviewed. Patients were stratified into CAD and non CAD cohorts. Obstructive CAD was defined angiographically. Statistical analysis utilised Chi-square and Student’s t-tests. Results: The cohort’s mean age was 55.6±9.3 years; 127 (63.5%) were males (63.5%). Prevalences of hypertension, diabetes mellitus, dyslipidaemia, and tobacco use were 71 (35.5%), 64 (32%), 30 (15%), and 15 (7.5%), respectively. Patients with CAD were significantly older (mean age: 59.2±8.5 vs 53.8±9.1 years; p<0.001) and predominantly males (72 (73.5%) vs. 55 (53.9%); p=0.005). Increasing age and diabetes mellitus emerged as independent predictors of CAD in multivariate analysis (OR 1.09, 95% CI 1.05-1.13; p<0.001 and OR 2.49, 95% CI 1.10-5.63; p=0.028, respectively). No statistically significant association was observed between CAD status and valves involved namely, Mitral Valve Disease (MVD), Aortic Valve Disease (AVD) and combined valve disease or valve surgery performed. AVD showed a non significant trend toward higher prevalence in the CAD group (p=0.11). Left Anterior Descending (LAD) artery was the most frequently diseased vessel {49 (50%)}. Left Ventricular Ejection Fraction (LVEF) was marginally lower in the CAD arm (54.2±12.4% vs 57.1±11.3%; p=0.05), while Atrial Fibrillation (AF) lacked statistical correlation (p=0.89). Conclusion: The CAD in Indian valve replacement candidates was independently associated with advanced age, diabetes mellitus, and standard atherosclerotic risk factors. There was no statistically significant association between presence of CAD and the underlying valve pathology, or the type of surgery performed. Preoperative angiographic screening is critical for precise surgical planning, which should be dictated not only by age but by the presence of cardiovascular risk factors.