Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

Steve S. Lin, Michael S. Lauer, Craig R. Asher, Delos M. Cosgrove, Eugene Blackstone, James D. Thomas, Mario J. Garcia

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. Methods: A total of 722 patients (67% men; age, 61 ± 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A boot-strap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (≤5%) patients. Obstructive coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. Results: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus, and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. Conclusion: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

Original languageEnglish (US)
Pages (from-to)894-901
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume121
Issue number5
DOIs
StatePublished - May 1 2001
Externally publishedYes

Fingerprint

Mitral Valve
Coronary Artery Disease
Mitral Valve Prolapse
Logistic Models
Coronary Angiography
Angiography
Cost Savings
Hyperlipidemias
ROC Curve
Diabetes Mellitus
Myocardial Infarction
Hypertension
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration. / Lin, Steve S.; Lauer, Michael S.; Asher, Craig R.; Cosgrove, Delos M.; Blackstone, Eugene; Thomas, James D.; Garcia, Mario J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 121, No. 5, 01.05.2001, p. 894-901.

Research output: Contribution to journalArticle

Lin, Steve S. ; Lauer, Michael S. ; Asher, Craig R. ; Cosgrove, Delos M. ; Blackstone, Eugene ; Thomas, James D. ; Garcia, Mario J. / Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration. In: Journal of Thoracic and Cardiovascular Surgery. 2001 ; Vol. 121, No. 5. pp. 894-901.
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abstract = "Objectives: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. Methods: A total of 722 patients (67{\%} men; age, 61 ± 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A boot-strap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (≤5{\%}) patients. Obstructive coronary atherosclerosis was defined as 50{\%} or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. Results: One hundred thirty-nine (19{\%}) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus, and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3{\%}) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30{\%} of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. Conclusion: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.",
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