The relationship between coronary risk factors and coronary artery disease in patients with valvular heart disease was studied prospectively in 387 consecutive patients undergoing routine coronary arteriography prior to valve replacement.Coronary artery disease was as common in patients with mitral valve disease (31.9) as in those with aortic valve disease (26.8) Although it occurs more frequently in patients with angina (45.7) significant coronary artery disease is found in 19.2(47 of 245) of those without angina (P<0.001), suggesting that the presence of angina alone is an unreliable indicator of significant coronary disease. The prevalence and severity of significant coronary artery disease increases progressively as the number of coronary risk factors also increase (P<0.001) but the prevalence is low (3) in patients in whom both angina and coronary risk factors are absent. These findings suggest that preoperative coronary arteriography might be omitted in this latter group of patients.
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