Coronary artery calcium score and coronary computed tomographic angiography for major perioperative cardiovascular complications in symptomatic diabetic patients undergoing trans-femoral amputation

Abstract

ObjectivePerioperative risk for major cardiovascular events (MACE) is particularly high in patients with type 2 diabetes undergoing surgery for trans-femoral amputation (TFA). The aim of this study was to identify prognostic value of coronary calcium score (CACS) and coronary computed tomographic angiography (CCTA) for perioperative MACE in these patients. MethodsIn this prospective single center interventional cohort study, we evaluated 331 consecutive symptomatic patients with diabetes and without history of coronary intervention or myocardial infarction (MI) undergoing TFA in 2013. 179/331 patients (54%) had no contraindications for CCTA and were included in the study cohort. ResultsAll patients had revised cardiac risk index score of 3 or more points (class IV with MACE rate of 11%). Increasing calcium score was associated with increasing severity of CAD by CCTA and incidence of cardiovascular complications. During 25weeks of follow-up, there were 43 MACE (24%), 28(15.6%) of them cardiac death. Post-operative event rate increased in patients with increasing CACS from 10% with CACS 1–99 to 84% with CACS>1000 (p<0.001). Similarly, there were more post-operative events in patients with 3- and 2-vessels disease compared to 1-vessel obstructive and non-obstructive CAD (74.1% and 34.1% vs. 10.5% and 6.5%, p<0.001). ConclusionsPredicative value of CCTA and CACS is high for perioperative MI and death in patients with type 2 diabetes undergoing non-cardiac surgery for TFA. It may be considered as a valuable tool for preoperative risk assessment in these patients, where stress tests are not feasible and more sophisticated technical equipment is not available.