Coronary computed tomography angiography to predict myocardial injury in patients undergoing high-risk cancer surgery

BACKGROUND: Myocardial injury is one of the most common complications after surgery and is associated with increased mortality in high-risk patients. The aim of this study was to evaluate whether preoperative coronary computed tomography angiography can predict the occurrence of myocardial injury in cancer patients undergoing high-risk surgery. METHODS: Patients diagnosed with solid tumors who possessed at least two cardiovascular risk factors and were scheduled for high-risk surgeries between August 2017 and July 2021 were included. All subjects underwent preoperative coronary computed tomography angiography, and troponin levels were measured immediately after surgery and daily within the first three days after surgery. The primary outcome was the occurrence of myocardial injury within 72 hours, defined as high-sensitivity troponin T values ≥0.014 ng/mL. RESULTS: A total of 184 patients were included. The median age was 66 years (IQR: 60; 73 years). Myocardial injury occurred in 87 patients (48%). The logistic regression identified the following as myocardial injury predictors: bladder tumor (odds ratio [OR] 10.40 [95% confidence interval 95% CI] 2.51; 43.20, P=0.001), esophageal tumor (OR 7.39 [95% CI 2.27; 24.08], P=0.001), longer anesthesia time (OR 1.24 [95% CI 1.09; 1.43], P=0.002), calcium score of 401-1000 (OR 5.92 [95% CI 1.29; 27.08, P=0.022]), and calcium score >1000 (OR 4.62 [95% CI 1.18; 18.04, P=0.028]). CONCLUSIONS: In cancer patients undergoing high-risk surgery, high calcium score on coronary computed tomography angiography identified patients who developed postoperative myocardial injury. Coronary computed tomography angiography might be considered in the surgical risk stratification of this population.