Angina pectoris in Severe Aortic Stenosis

Abstract

We studied the value of angina pectoris as a predictor of significant coronary artery disease (CAD) in very elderly patients with severe aortic stenosis (AS). The study population consisted of patients with age at least 70 years who were referred for balloon aortic valvuloplasty (n = 90 patients). Routine coronary angiography was performed before the valvular intervention. Patients were grouped according to the presence or absence of angina pectoris. Of the patients with angina pectoris, 78% had obstructive (>50% diameter stenosis) CAD on coronary angiogram, while only 17% of patients without angina pectoris had obstructive CAD (p < 0.01). Angina pectoris had a sensitivity of 78% and a specificity of 82% for prediction of obstructive CAD. This suggests that in elderly patients with severe AS, the presence of angina pectoris is a strong determinant of CAD, and the absence of angina strongly suggests absence of obstructive CAD. In a very elderly population, appropriate decision-making with respect to AS management should not await diagnostic coronary angiography.

Diretriz Brasileira de Valvopatias - SBC 2011/ I Diretriz Interamericana de Valvopatias - SIAC 2011

“…Por sua vez, DAC é um achado frequente em idosos sintomáticos. Em pacientes acima de 70 anos de idade, angina é um forte determinante de DAC (sensibilidade de 78%, especificidade 82%) 331 . Outro fator também associado à presença de DAC é a calcificação da valva aórtica (90%) 332 .…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…998,1005,1011 In elderly patients (greater than 70 years old), angina is a strong determinant of CAD (sensitivity 78%, specificity 82%). 1012 Calcification of the aortic valve is also associated with a high presence of CAD (90%). 1013 In general, because angina is a poor marker of CAD in patients with AS, coronary angiography is recommended in symptomatic patients before AVR in men older than 35 years; premenopausal women older than 35 years with coronary risk factors, as well as asymptomatic men older than 45 years; women older than 55 years; and those with 2 or more coronary risk factors.…”

Valor preditivo da angina em detectar doença coronariana em pacientes com estenose aórtica grave a partir da quinta década de vida

“…Based on a study with 88 consecutive AS patients who needed AVR, Exadactylos et al, also suggested that coronary angiography would not be necessary in patients without angina 15 . Despite the fact that the authors of these two last studies suggested that coronary angiography could be unnecessary in cases of patients without angina, approximately 10.3% of the patients in the first study 14 and 15% in the second study 15 presented CAD in the absence of typical angina pectoris. In our study, in analyzing only the 76 patients over 70 years of age (data not expressed in the results), we verified that 68.6% of those with angina had CAD, whereas among those without angina 60% had CAD.…”