Prevalence of Coronary Artery Disease in Rheumatic Heart Disease and Comparison of Demographic and Coronary Artery Disease Profile with Atherosclerotic Coronary Artery Disease

Aim: In India, coronary angiography (CAG) is usually performed in rheumatic heart disease (RHD) patients before valve replacement surgery if there is any suspicion of coronary artery disease (CAD) or the patient is aged >40 years. The aims of the present study were (1) to find the prevalence of CAD, CAD patterns and its association with various CAD risk factors in RHD patients and (2) to study the association of inflammation seen in RHD with prevalence of CAD. Materials and Methods: The records of 1204 RHD patients who underwent CAG before surgery from 2001 to 2010 were evaluated. Patients of RHD with significant CAD (≥50% stenosis) were compared with age- and sex-matched patients of RHD with no CAD and atherosclerotic CAD patients. All RHD patients with embolic acute coronary artery syndrome were excluded from the study. Results: One-hundred and nine (9.05%) RHD patients had significant CAD (males 65.1% and females 34.9%). The mean age was 52.8 ± 8.6 years (52.3 ± 8.9 years for males and 53.6 ± 8 years for females). Involvement of mitral valve was seen in 66.1%, aortic valve in 7.3% and both valves in 26.6% in these patients. Single-vessel disease, double-vessel disease or triple-vessel disease was present in 58.7%, 27.5% and 13.8%, respectively. Left main coronary artery was involved in 4.6% of the cases. Left anterior descending (LAD) was the most common vessel involved (68.9%), followed by right coronary artery (44.1%) and left circumflex artery (42.3%). Univariate analysis showed that polymorphonuclear leucocyte count was significantly higher ( P = 0.037; odds ratio: 1.03 with 95% confidence interval: 1.001–1.056) in RHD CAD patients than the atherosclerotic CAD patients. Conclusion: The prevalence of CAD in patients with RHD is similar to other Indian studies but lower than the Western countries. Single-vessel involvement, mostly LAD, is more common among these patients. CAD risk factor is less common than the atherosclerotic patients. CAD in these patients may be attributed to the inflammatory state seen with RHD.