Usefulness of preoperative coronary computed tomography angiography in high risk non-cardiovascular surgery old patients with unknown or suspected coronary artery disease

Xue-Ming Li,Zhi-Peng Wen,Jiao Pei,Guo-Hui Xu,Peng Zhou,Huai-Ming Wang,Jing Reng,Zhong-Zhi Xu,Wei Dai

doi:10.1186/s12872-020-01731-7

Abstract

BackgroundCumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment. With the increasing elderly population, many patients scheduled for non-cardiovascular surgery may have concomitant coronary artery disease (CAD). The aim of this study was to investigate the usefulness of preoperative CCTA to rule out or detect significant CAD in this cohort of patients and the impact of CCTA results to clinical decision-making.Methods841 older patients (age 69.5 ± 5.8 years, 74.6% males) with high risk non-cardiovascular surgery including 771 patients with unknown CAD and 70 patients with suspected CAD who underwent preoperative CCTA were retrospectively enrolled. Multivariate logistic regression analysis was performed to determine predictors of significant CAD and the event of cancelling scheduled surgery in patients with significant CAD.Results677 (80.5%) patients had non-significant CAD and 164 (19.5%) patients had significant CAD. Single-, 2-, and 3- vessel disease was found in 103 (12.2%), 45 (5.4%) and 16 (1.9%) patients, respectively. Multivariate analysis demonstrated that positive ECG analysis and Agatston score were independently associated with significant CAD, and the optimal cutoff of Agatston score was 195.9. The event of cancelling scheduled surgery was increased consistently according to the severity of stenosis and number of obstructive major coronary artery. Multivariate analysis showed that the degree of stenosis was the only independent predictor for cancelling scheduled surgery. In addition, medication using at perioperative period increased consistently according to the severity of stenosis.ConclusionsIn older patients referred for high risk non-cardiovascular surgery, preoperative CCTA was useful to rule out or detect significant CAD and subsequently influence patient disposal. However, it might be unnecessary for patients with negative ECG and low Agatston score.Trial registration Retrospectively registered.

Highlights

Cumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment
In older patients referred for high risk non-cardiovascular surgery, preoperative CCTA was useful to rule out or detect significant coro‐ nary artery disease (CAD) and subsequently influence patient disposal
The main findings of this study were that (1) preoperative CCTA can rule out or detect significant CAD and demonstrate the severity of disease in older patients referred for high risk non-cardiovascular surgery; (2) positive ECG analysis and Agatston score were independently associated with significant CAD; (3) Cancelling scheduled surgery and medication using increased consistently according to the severity of CAD detected by CCTA

Summary

Introduction

Cumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment. With the increasing elderly population, many patients scheduled for non-cardiovascular surgery may have concomitant coronary artery disease (CAD) [1]. Invasive coronary angiography (ICA) is a well-established diagnostic procedure, but it is rarely recommended to assess the risk of non-cardiovascular surgery in routine tests unless the patient has an independent indication for angiography [1, 2]. It has high radiation-exposure and may cause unnecessary and unpredictable delay in an already planned surgical intervention [2]. As to the risk stratification of preoperative CCTA, there was no definitive recommendations in previous ACC/AHA and ESC/ESA guidelines [1, 2], and it was not recommended in the recent Canadian Cardiovascular Society guidelines [6]

Objectives

Methods

Results

Discussion

Conclusion