Clinical factors associated with positive coronary angiography in patients undergoing cardiac surgery
Authors: Wang Rui , Gao Wei , Shen Ruopei , Che Xinyu , Xia Yan , Chen Ao , Lu Danbo , Ma Jiaqi , Chen Hungju , Chen Zhangwei , Qian Juying , Ge Junbo 
Published: May 2024

Background: Many cardiovascular disease patients undergoing valve repair/replacement or other surgeries in hospitals require coronary angiography (CAG) examination. Positive results may lead to simultaneous bypass grafting, while negative results or insignificant stenosis require no treatment. Although informative, there is still a need to improve the necessity of the CAG examinations, which is expensive and expose patients to a large amount of radiation. Our aim is to develop a model to determine the necessity of CAG, reducing unnecessary procedures.
Methods: A retrospective observational cohort study was conducted on 5086 patients who underwent valve repair/replacement or other cardiac surgeries at Zhongshan Hospital and received coronary angiography between 2016 and 2021. The criteria for a positive coronary angiogram are defined as ≥50% reduction in luminal diameter by invasive coronary angiography. We analyzed the clinical and echocardiographic characteristics of patients with positive coronary angiography results, evaluated the independent clinical predictors of positive coronary angiography patients using multiple logistic regression analysis, and compared their predictive performance using the area under the receiver operating characteristic curve with 100 repeated random permutations.
Results: Among the study participants, 671 individuals exhibited positive results on coronary angiography. Those with positive findings were notably older (mean age 61 years vs. 65 years, p < 0.001) and comprised a higher proportion of males (52% vs. 69%, p < 0.001). Additionally, they demonstrated a higher prevalence of hypertension (22% vs. 36%, p < 0.001), diabetes (5% vs. 10%, p < 0.001), and current smoking (15% vs. 21%, p < 0.001), as well as higher left ventricular end-systolic dimension (LVSD) (33mm vs. 34mm, p = 0.019) and lower left ventricular ejection fraction (LVEF) (64% vs. 63%, p < 0.001). Moreover, they were more likely to have a history of myocardial infarction (0.1% vs. 0.9%, p < 0.001) and cerebrovascular disease (2.7% vs. 4.6%, p = 0.005). In multiple logistic regression analysis, old age(≥60 years) (odds ratio [OR], 2.270; 95% confidence interval [CI], 1.893–2.722; p < 0.001), men(OR, 2.025; 95% CI, 1.673–2.452; p < 0.001), hypertension(OR, 1.532; 95% CI, 1.279–1.836; p < 0.001), diabetes mellitus(OR, 1.730; 95% CI, 1.293–2.314; p < 0.001), Levf ≤ 58%( OR, 1.474; 95% CI, 1.198–1.815; p < 0.001), LVSD ≤ 30mm (OR, 1.279; 95% CI, 1.051–1.556; p = 0.014),history of myocardial infarction(OR, 8.298; 95% CI, 2.109–32.651; p = 0.002) were associated with positive coronary angiography. Prediction ability for positive coronary angiography increased proportionally when these 4 factors were sequentially combined (P < 0.001).
Conclusion: Male patients aged 60 and above with hypertension, diabetes, left ventricular ejection fraction (LVEF) less than or equal to 58%, LVSD less than or equal to 30mm, and a history of myocardial infarction may require coronary angiography examination. Further research is needed to guide clinical surgeons in determining whether patients need coronary angiography.