Performing computed tomography coronary angiography as a method for evaluation of post-operative cardiac event risk in noncardiac surgery

Abstract

Purpose: Computed tomography coronary angiography (CTCA) as the role of preoperative evaluation for risk stratification was not well investigated yet. We studied the potent of predicting the post-operative cardiac events in patients who were undergoing noncardiac surgery, whether the scoring of stenosis in coronary arteries that were measured with CTCA. Method: We evaluated the Revised Cardiac Risk Index (RCRI) to the clinically determined risk and CTCA plaque extent and distribution graded by several scoring system such as Duke Jeopardy Score, Modified Duke Score, Segment stenosis score and Segments-at-risk score in 1195 noncardiac surgery cases, respectively. The primary end point was post-operative cardiac events, which was defined as acute coronary syndrome including myocardial infarction and primary cardiovascular death within 30 days after surgery. Results: In univariated analysis, the respective variables demonstrated the results of p-value, RCRI (p < 0.001), Duke Jeopardy Score (p = 0.004), Modified Duke Score (p < 0.001), Segment stenosis score (p = 0.041) and Segments-at-risk score (p = 0.181). When comparing the receiver operating characteristic (ROC) curves RCRI and various scoring indices of coronary artery disease (CAD) measured by CTCA, none of these indices were better than the clinically determined RCRI (AUC= 0.709, 95% confidence internals 0.571 to 0.628). Conclusion: The predictive power of post-operative cardiac events in CTCA was inferior to RCRI. The results of our study did not support the use of routine CTCA before noncardiac surgery because the evidences were not enough as the superiority of CTCA.