Risk stratification using computed tomography coronary angiography in patients undergoing intermediate-risk noncardiac surgery

J Am Coll Cardiol. 2013 Feb 12;61(6):661-8. doi: 10.1016/j.jacc.2012.09.060.

Abstract

Objectives: This study evaluated whether coronary artery calcium scores (CACS) and the degree of stenosis that were measured with computed tomography coronary angiography (CTCA) predicted post-operative cardiovascular events in patients who were undergoing intermediate-risk noncardiac surgery.

Background: Cardiovascular complications are important causes of mortality and morbidity in patients undergoing major noncardiac surgeries.

Methods: A total of 239 patients underwent CTCA before intermediate-risk noncardiac surgeries. We measured CACS and the degree of stenosis with CTCA and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores. Post-operative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, ventricular arrhythmia with hemodynamic compromise, and complete heart block.

Results: Nineteen patients (8%) had post-operative cardiac events. The variables that correlated with the occurrence of cardiac events were RCRI (p < 0.001), CACS (p < 0.001), the presence of significant coronary artery stenosis (diameter stenosis ≥50%) (p = 0.01), and multivessel coronary artery disease (p < 0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 113 (sensitivity, 0.79; specificity, 0.61; area under the curve, 0.762). When comparing ROC curves of the combination models of RCRI, high CACS (≥113), and the presence of multivessel disease, RCRI plus high CACS, RCRI plus multivessel disease, and RCRI plus high CACS plus multivessel disease were significantly more predictable of post-operative cardiovascular events than RCRI alone.

Conclusions: In the pre-operative risk stratification of patients who were undergoing intermediate-risk noncardiac surgeries, CTCA evaluations showed additive value to RCRI.

MeSH terms

  • Aged
  • Coronary Angiography / methods*
  • Coronary Stenosis / diagnosis
  • Coronary Stenosis / etiology
  • Coronary Vessels / pathology*
  • Female
  • Heart Diseases* / etiology
  • Heart Diseases* / mortality
  • Heart Diseases* / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control*
  • Predictive Value of Tests
  • Preoperative Care / methods
  • ROC Curve
  • Risk Assessment / methods*
  • Risk Factors
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / statistics & numerical data
  • Survival Analysis
  • Tomography, X-Ray Computed / methods*
  • Vascular Calcification / complications
  • Vascular Calcification / diagnostic imaging*