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Impact of coronary artery disease on in-hospital mortality in patients with aortic valve disease

Results from the German ALKK registry

Einfluss einer koronaren Herzkrankheit auf die intrahospitale Mortalität bei Patienten mit Aortenvitium

Resultate des ALKK-Registers

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Abstract

Objective

Although aortic valve disease (AVD) is frequently associated with coronary artery disease (CAD), little is known about the impact of significant coronary artery disease on mortality after diagnostic cardiac catheterization in patients with AVD.

Methods

We analyzed data of the coronary angiography registry of the “Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte” (ALKK) in Germany. The primary endpoint was in-hospital mortality.

Results

A total of 1427 consecutive patients with AVD (438 patients with CAD versus 989 patients without CAD) underwent diagnostic catheterization in 2006 in 42 hospitals. All cause in-hospital mortality was more than threefold higher in patients with CAD (16/438; 3.7%) as compared to patients without CAD (12/989; 1.2%; p < 0.01; OR 3.09, 95% CI 1.45–6.58). Even after adjustment for age, sex, presence of diabetes mellitus and renal insufficiency, in-hospital all cause mortality remained statistically significant different between the two groups (OR 2.4; 95% CI 1.09–5.28; p < 0.01). Several factors, such as transient ischemic attack/stroke, volume of contrast agent, and left heart catheter-associated complications could not be identified as possible causes for the increase in mortality.

Conclusion

This analysis in patients with the leading diagnosis of AVD shows a significantly higher in-hospital mortality after diagnostic cardiac catheterization in case of an accompanying CAD. However, further studies are necessary to identify the driving force for the increase in mortality.

Zusammenfassung

Hintergrund

Aortenklappenvitien sind häufig mit einer koronaren Herzkrankheit (KHK) vergesellschaftet. Der Einfluss einer begleitenden KHK auf die intrahospitale Mortalität nach einer diagnostischen Herzkatheteruntersuchung bei Patienten mit einem führenden Aortenklappenvitium ist bisher unbekannt.

Methoden

Die Analyse erfolgte mit den Daten des Linksherzkatheterregisters der deutschen „Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte“ (ALKK). Als primärer Endpunkt der Analyse wurde die intrahospitale Mortaliät gewählt.

Ergebnisse

Bei insgesamt 1427 konsekutiven Patienten mit der Hauptdiagnose eines Aortenklappenvitiums (438 Patienten mit begleitender KHK versus 989 Patienten ohne KHK) wurde im Jahr 2006 in 42 Zentren eine diagnostische Herzkatheteruntersuchung durchgeführt. Patienten mit begleitender KHK hatten im Vergleich zu Patienten ohne KHK eine 3-fach höhere intrahospitale Mortalität [3,7% (16/438) versus 1,2% (12/989); p<0,01; OR: 3,09; 95%-KI: 1,45–6,58)]. Auch nach Adjustierung für Einflussfaktoren wie Alter, Geschlecht, Diabetes mellitus und Niereninsuffizienz blieb die intrahospitale Mortalität statistisch signifikant verschieden zwischen den beiden Gruppen (OR: 2,4; 95%-KI: 1,09–5,28; p<0,01). Katheterassoziierte Komplikationen bzw. die verwendete Kontrastmittelmenge konnten als Ursachen für den Unterschied ausgeschlossen werden.

Schlussfolgerung

Patienten mit der Hauptdiagnose eines Aortenklappenvitiums haben nach Durchführung einer diagnostischen Herzkatheteruntersuchung im Fall einer begleitenden KHK eine signifikant höhere intrahospitale Mortalität. Zur Klärung der genauen Ursachen sind weitere Studien notwendig, damit diese dann im klinischen Alltag berücksichtigt werden können.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, University of Leipzig – Heart Center, Struempellstr. 39, 04289, Leipzig, Germany

    R. Höllriegel MD, A. Linke & G. Schuler

  2. Institut für Herzinfarktforschung Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany

    M. Hochadel & J. Senges

  3. Department of Cardiology, Herz- und Gefäßklinik, Bad Neustadt (Saale), Germany

    S. Kerber

  4. Heart Center Bremen, Klinikum Links der Weser, Bremen, Germany

    R. Hambrecht

  5. Department of Cardiology, Helios Heart Center, Siegburg, Germany

    E. Grube

  6. IIIrd Medical Department – Cardiology, Krankenhaus der Barmherzigen Brüder, Trier, Germany

    K.E. Hauptmann

  7. Medical Department B, Klinikum Ludwigshafen, Ludwigshafen, Germany

    R. Zahn & U. Zeymer

Authors
  1. R. Höllriegel MD
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  2. A. Linke
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  3. M. Hochadel
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  4. G. Schuler
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  5. S. Kerber
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  6. R. Hambrecht
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  7. E. Grube
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  8. K.E. Hauptmann
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  9. R. Zahn
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  10. U. Zeymer
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  11. J. Senges
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Corresponding author

Correspondence to R. Höllriegel MD.

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Höllriegel, R., Linke, A., Hochadel, M. et al. Impact of coronary artery disease on in-hospital mortality in patients with aortic valve disease. Herz 38, 387–390 (2013). https://doi.org/10.1007/s00059-012-3712-z

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  • DOI: https://doi.org/10.1007/s00059-012-3712-z

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