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Ostium secundum atrial septal defect (ASD) is a common cardiac anomaly that may be first encountered in the adult because patients with ASD are usually asymptomatic when they are young. Guidelines for coronary angiography suggest that all patients aged older than 50 years receive coronary angiography before cardiac or vascular surgery. However, the prevalence of coronary artery disease (CAD) in patients with ostium secundum ASD is still unclear. The aims of this study were to investigate the prevalence of and the risk factors for CAD in patients aged elder than 50 years with ostium secundum ASD.
A retrospective study was performed on patients aged > 50 years old with ostium secundum ASD. All the patients underwent selective coronary angiography (SCA) after comprehensive clinical evaluation, and the presence of CAD and the degree of stenosis were observed. Significant CAD was defined as the presence of more than 50% stenotic lesions during SCA. The risk factors for CAD including gender, age, body mass index, blood lipid, ASD size, pulmonary pressure and combined diseases were investigated.
A total of 525 patients (157 men, 29.9%) aged from 50 to 74 (58 ± 6) years with body mass index of 23.5 ± 3.4 kg/m2 were included in this study. 131 (25.0%) patients with systemic hypertension, 32(6.1%) with diabetes, and 156 (29.7%) with atrial flutter/ fibrillation were detected. The size of ASD was 22.3 ± 8.9 mm and the pulmonary systolic/diastolic pressures were 44 ± 16 / 16 ± 7 mmHg. Among the patients, significant CAD was detected in 68 patients (13.0%); 46 patients had one vessel disease, 18 had two vessel disease and 4 had three vessel disease. Patients with CAD exhibited male preponderance (19.1% versus 10.3%, P<0.01) and the prevalence of CAD increased with age. No significant differences were observed in body mass index, ASD size, pulmonary pressure, levels of cholesterol, triglyceride and low density lipoprotein, and the percentage of atrial flutter/ fibrillation between the patients with CAD and those without CAD. The prevalence of CAD was 7.7% in patients with ASD without systemic hypertension and diabetes, 22.6% with systemic hypertension, 31.2% with diabetes and 50.0% with both, respectively. Systemic hypertension and diabetes were the independent risk factors for CAD in patients with ASD. The overall prevalence of CAD was 13.0% in men and 3.5 in women aged from 50 to 54 years old, and the prevalence of CAD in patients without systemic hypertension and diabetes at the same age was 5.6% in men and 2.6% in women, respectively.
Whether routine SCA be performed to detect CAD in patients with ASD referred for cardiac surgery or device closure depends on not only age but also gender and risk factors. Routine SCA is recommended in man combined with hypertension and diabetes even the age is younger than 50 years. However, it seems reasonable to delay the cut-off age to perform SCA to 55 years for woman without hypertension and diabetes.