The prevalence of angiographically significant coronary artery disease in patients with isolated secundum atrial septal defect

OBJECTIVES: Atrial septal defect (ASD) and coronary artery disease (CAD) may coexist in adults, especially in the elderly. The aim of this study was to determine the prevalence of CAD in patients undergoing both catheterization for ASD and selective coronary angiography and to evaluate the relationship of CAD with symptoms and risk factors. STUDY DESIGN: The study included 138 consecutive patients (40 males, 98 females; mean age 54+/-10 years; range 31 to 74 years) who underwent catheterization for isolated secundum ASD and selective coronary angiography at the same session. The mean shunt was 2.6+/-0.8 in the patient group. Significant CAD was defined as the presence of = or >50% stenotic lesions during angiography. RESULTS: Significant CAD was detected in 12 patients (8.7%). Patients with CAD exhibited a higher mean age (61+/-10 vs 54+/-10 years, p=0.016) and male preponderance (83.3% vs 23.8%, p<0.001). Risk factors and hemodynamic parameters did not differ between the two groups. Laboratory parameters were also similar except for a higher triglyceride level in patients without CAD (123+/-64 mg/dl vs 71+/-40 mg/dl, p=0.006). Angina pectoris was present in four patients (33.3%) in the CAD group, compared to 28 patients (22.2%) without CAD. For angina pectoris to predict CAD, the sensitivity, specificity, positive and negative predictive rates were 33.3%, 77.8%, 12.5%, and 92.5%, respectively. The corresponding figures were 50.0%, 33.3%, 6.7%, and 87.5% for at least one risk factor, and 16.7%, 82.5%, 8.3%, and 91.2% for combination of angina pectoris with at least one risk factor. CONCLUSION: Despite increased prevalence of CAD in adults, its prevalence is relatively low in patients with ASD. Thus, routine coronary angiography performed to detect CAD in patients with ASD increases complications and decreases cost-effectiveness.