{Reference Type}: Journal Article
{Title}: Routine Coronary Angiography in Adults Undergoing Percutaneous Atrial Septal Defect Closure: Implications for Practice Guidelines.
{Author}: Olesovsky C;Muthuppalaniappan A;Schneider H;Abrahamyan L;Meier L;Alnasser S;Shah A;Bach Y;Frankfurter C;Benson L;Osten M;Horlick EM;
{Journal}: J Invasive Cardiol
{Volume}: 33
{Issue}: 10
{Year}: Oct 2021
{Factor}: 1.711
{Abstract}: <B>OBJECTIVE: </B>Secundum atrial septal defect (ASD) is a common adult congenital heart lesion for which percutaneous closure offers treatment in patients with suitable anatomy. We sought to determine the outcomes of coronary angiography in a population of adults >40 years of age who were undergoing percutaneous ASD closure.<BR><B>METHODS: </B>Patients >40 years of age who underwent ASD closure between 2009-2016 were included in this retrospective chart review. Coronary angiograms were reviewed by 2 independent reviewers to evaluate the presence and degree of coronary artery disease (CAD) and the resulting clinical sequelae.<BR><B>RESULTS: </B>A total of 398 patients underwent ASD closure, and 300 had coronary angiography at the time of closure. Mild CAD (10%-39% vessel stenosis) was found in 33 patients (11.0%), moderate CAD (40%-69% vessel stenosis) in 23 patients (7.7%), and severe CAD (≥70% vessel stenosis) in 25 patients (8.3%). Of the 48 patients with moderate to severe CAD, 24 had proximal vessel disease and 21 had multivessel disease. Four patients (8.3%) with moderate to severe CAD subsequently underwent percutaneous interventions, 16 patients (33.3%) had medication changes, 16 patients (33.3%) had perfusion testing followed by medication changes, and 12 patients (25%) had no changes in their medical management.<BR><B>CONCLUSIONS: </B>Given the prevalence of CAD in this population, routine coronary angiography at the time of ASD closure should be reserved for patients with an unfavorable cardiovascular risk profile, who have a higher likelihood of CAD. While patients with ASDs suffer from chest pain and dyspnea both before and after percutaneous closure, few have established CAD.