Prevalence & Pattern of Coronary Artery Disease in Patients with Valvular Heart Disease Undergoing Pre-Operative Angiography

Abstract

Objectives: This study aims to evaluate the prevalence and angiographic patterns of coronary artery disease (CAD) in patients diagnosed with valvular heart disease (VHD) undergoing preoperative coronary angiography. Emphasis is placed on the involvement of specific coronary vessels and the occurrence of multivessel disease across different types of valvular lesions. Methodology: A total of 335 patients, aged between 18 and 60 years, who had undergone coronary angiography prior to valve surgery, were retrospectively analyzed. CAD was defined as ≥50% stenosis in at least one major coronary artery. The prevalence and distribution of CAD were assessed in relation to various valvular pathologies, including aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS), and mitral regurgitation (MR). Results: The highest prevalence of CAD was found in patients with MR (85.7%) and AS (56.3%), with the left anterior descending (LAD) artery being the most frequently involved vessel. In contrast, isolated left circumflex (LCx) artery involvement was exclusively observed in patients with AR (100%). Three-vessel CAD (3VCAD) was most common among MR patients (85.7%). Combined LAD + LCx involvement was seen in 33.3% of cases, while MS showed a comparatively lower CAD prevalence. Left main (LM) artery involvement, although rare, was most frequently found in MS patients (16.7%). Conclusion: This study highlights a substantial burden and distinct angiographic patterns of CAD among VHD patients undergoing preoperative evaluation. Given the high prevalence, particularly among those with AS and MR, routine coronary angiography should be considered essential in pre-surgical assessment. Further large-scale studies are warranted to strengthen diagnostic and management protocols in local populations.