Abstract 17566: Prevalence of Coronary Artery Disease Detected by Computed Tomography Angiography in Adult Patients With Coarctation of the Aorta
Background: Natural history studies suggest that patients (pt) with coarctation of the aorta (CoA) have decreased survival, predominantly related to premature coronary artery disease (CAD). We aim to detect the prevalence of CAD in adult pt with CoA undergoing computed tomography angiography (CTA) and to look for any risk factors associated with the presence of CAD.
Methods: The medical records and images from adult pt with CoA undergoing clinically indicated CTA from January 1, 2006 to May 30, 2013 were reviewed.
Results: Clinically indicated CTA was performed in 49 adult pt (32 male), mean age 42 ±16 yrs. Image quality was adequate for evaluation of the coronary arteries in 48. The majority had a prior surgical repair (n=37). Multiple procedures were common; 19 pt had at least 2 operations and 7 had stenting of recurrent CoA. CAD was present in 16 (33%). 9 pt had 3-vessel disease. High-risk features (complete vessel occlusion, low attenuation plaque with positive remodeling, or prior coronary stent) were present in 5; another 3 pt had stenosis ≥50%. Pt with CAD were older than those without (57 ±8.7 yrs vs 34 ±12.6 yrs, p<0.0001), had a larger body mass index (30.6 ±5.2 vs 27.2 ±5.2, p=.04) and were more likely to be have diabetes (25% vs 3%, p=0.04). The presence of hypertension (81% vs 66%, p=ns), dyslipidemia (56% vs 38%, p=ns), and any smoking history (63% vs 34%, p=ns) were not significantly different. Chest pain (0 vs 19%, p=ns) and dyspnea on exertion (44% vs 22%, p=ns) were not associated with the presence of CAD. There was no difference in the use of antihypertensives, statins, or aspirin between the two groups. Cholesterol levels and systolic blood pressure were also similar. No CAD was present in the 18 pt younger than age 35; CAD was present in 1 of the 6 (17%) pt ages 35-44, 5 of 12 (42%) pt ages 45-54, and 10 of 12 (83%) of pt older than age 55.
Discussion: CAD, as detected by CTA, is present in 33% of adult pt with CoA and is present in the majority of pt above age 45. Older age, obesity, and DM were associated with the presence of CAD. Although symptoms and clinical events were uncommon, traditional risk factors for CAD were common, suggesting that aggressive risk factor modification is warranted in this patient population.
- © 2013 by American Heart Association, Inc.