Value of dual-source computed tomography angiography of coronary artery for preoperative evaluation of old patients scheduled for noncardiac surgery

Abstract

To assess the role of computed tomography angiography (CTA) using dual-source computed tomography in the preoperative evaluation of old patients scheduled for noncardiac surgery. A retrospective review of the clinical data of patients who underwent CTA in our hospital between May 2011 and May 2013 was performed, and totally 111 old patients with risk factors of coronary artery diseases scheduled for noncardiac surgery were found to coronary CTA for preoperative evaluation. Prospectively electrocardiograph-triggered sequence scan protocol with dual-source computed tomography was performed. The imaging quality, coronary artery stenosis, the treatment before operation, and perioperative complications were assessed. For 1 779 coronary artery segments in 111 patients, the number of evaluable segments was 1 676 (97.4%). The mean effective dose of CTA was (2.7 ± 0.9) mSv. Among them, 71 patients with coronary artery stenosis <50% underwent surgery without cardiac complication and 17 patients with coronary artery stenosis ≥ 70% underwent conventional coronary angiography and coronary angioplasty or bypass surgery. The sensitivity and specificity of CTA in detecting ≥ 50% stenosis were 95% and 96%, and the sensitivity and specificity of CTA in detecting ≥ 70% stenosis were 97% and 98%. For 19 patients with coronary artery stenosis between 50% and 70%, the levels of myocardial enzyme were transiently higher for two patients, and no other cardiac complication occurred. Coronary artery CTA is reliable in artery stenosis evaluation and can be used as cardiac risk stratification for old patients scheduled for noncardiac surgery.