Acute coronary syndrome in patients with aortic valve stenosis
M.B. MUKANOVA1, F.YU. KOPYLOV 2, R.N. KOMAROV2, I.I. SEREBRENNIKOV1, F.S. GAFUROV 3, A.N. KHUZIAKHMEDOV2, N.M. BABAKULOVA2, A.M. ISMAILBAEV2
1Moscow Regional Ambulance Facility, Krasnogorsk
2I.M. Sechenov First Moscow State Medical University, Moscow
3Egoryevsk Central Regional Hospital, Egoryevsk
Contact details:
Mukanova M.B. — Head of Balashikha branch of Ambulance Facility
Address: 3 Znamenskaya St., Krasnogorsk, Russian Federation, 143400, tel.: +7-926-451-04-95, е-mail: mmaruar@mail.ru
The purpose — to assess the acute coronary syndrome (ACS) clinical aspects in patients with aortic stenosis.
Material and methods. This is a retrospective single-center study that included comparison of hospital and midterm outcomes of ACS and aortic stenosis (n = 95, divided into the following groups: group 1 — severe aortic stenosis + ACS (n = 39); group 2 — moderate aortic stenosis + ACS (n = 28); group 3 — ACS without aortic stenosis (the control group selected using «Propensity matching» method) (n = 28)).
Results. Hospital mortality did not differ statistically between the groups. In group 1, there was a tendency to worse survival within 1 year. In groups with aortic malformation, ACS with ST segment elevation was less common — p = 0.0002 and p = 0.001, respectively. In group 1, 23.1% of patients had intact coronary arteries.
Conclusions. Severe aortic valve stenosis in some cases «mimics» acute coronary syndrome, which is indicated by significantly more frequent detection of intact coronary arteries in this cohort. Aortic stenosis of varying degrees does not lead to an increase in the frequency of early postoperative complications and 30-day mortality after PCI.
Key words: acute coronary syndrome, aortic stenosis, percutaneous coronary interventions, clinical outcomes.
REFERENCES
- Pibarot P., Dumesnil J.G. Improving assessment of aortic stenosis. J Am Coll Cardiol, 2012, vol. 60 (3), rr. 169–180.
- Iung B. Interface between valve disease and ischaemic heart disease. Heart, 2000, vol. 84 (3), rr. 347–352.
- Evora P.R., Arcêncio L., Rodrigues A.J. et al. Protective Effect of Aortic Stenosis on the Coronary Arteries. Hypothetic Considerations to an Old Enigma. Arq Bras Cardiol, 2016, vol. 106 (4), rr. 338–341.
- Nakib A., Lillehei C.W., Edwards J.E. The degree of coronary atherosclerosis in aortic valvular disease. Arch Pathol, 1965, vol. 80 (5), rr. 517–520.
- Exadactylos N., Sugrue D.D., Oakley C.M. Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. Br Heart J, 1984, vol. 51 (2), rr. 121–124.
- Morrison G.W., Thomas R.D., Grimmer S.F. et al. Incidence of coronary artery disease in patients with valvular heart disease. Br Heart J, 1980, vol. 44 (6), rr. 630–637.
- Cho E.J., Park S.J., Chang S.A. et al. Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis. Chin Med J (Engl), 2014, vol. 127 (22), rr. 3963–3969.
- Abdulali S.A., Baliga B.G., Clayden A.D. et al. Coronary artery luminal diameter in aortic stenosis. Am J Cardiol, 1985, vol. 55 (4), pp. 450–453.
- Goel SS, Agarwal S, Tuzcu EM et al. Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic valve replacement. Circulation, 2012, vol. 125, no. 8, rr. 1005-1013.