Key result
Pre-operative computed tomography coronary angiography, specifically CACS ≥113 (AUC 0.762), significantly improved the prediction of post-operative cardiovascular events compared to RCRI alone.
Why the study?
Cardiovascular complications cause significant mortality and morbidity in noncardiac surgery, leading researchers to evaluate whether CACS and stenosis degree on CTCA predict post-operative cardiovascular events in intermediate-risk procedures.
Does pre-operative CTCA evaluation improve the prediction of post-operative cardiovascular events compared to RCRI alone in patients undergoing intermediate-risk noncardiac surgery?
Observational (n=239)
Does pre-operative CTCA evaluation improve the prediction of post-operative cardiovascular events compared to RCRI alone in patients undergoing intermediate-risk noncardiac surgery?
Pre-operative CTCA evaluation of CACS and coronary stenosis provides additive prognostic value to the revised cardiac risk index for predicting cardiovascular events after intermediate-risk noncardiac surgery.
CTCA-derived CACS and stenosis may refine perioperative risk stratification in intermediate-risk noncardiac surgery; leaves open whether imaging-guided management reduces events.
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.
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Ahn et al. (2013) conducted an observational in Intermediate-risk noncardiac surgery (n=239). Computed tomography coronary angiography (CTCA) vs. Revised cardiac risk index (RCRI) was evaluated on Post-operative cardiovascular events (cardiac death, acute coronary syndrome, pulmonary edema, ventricular arrhythmia with hemodynamic compromise, and complete heart block) (AUC 0.762, p=<0.001). Pre-operative computed tomography coronary angiography, specifically CACS ≥113 (AUC 0.762), significantly improved the prediction of post-operative cardiovascular events compared to RCRI alone.
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