Key result
Preoperative stress perfusion CT with CCTA in patients scheduled for vascular surgery identified significant coronary artery stenosis in 39.6% and perfusion defects in 13.2%, but did not predict the low rate (4.4%) of perioperative cardiac events.
Why the study?
Does stress perfusion CT with CCTA predict perioperative cardiac events in patients undergoing vascular surgery?
Observational (n=91)
CT readers blinded to clinical data
No
Does stress perfusion CT with CCTA predict perioperative cardiac events in patients undergoing vascular surgery?
Stress perfusion CT with CCTA did not demonstrate a significant role in preoperative risk evaluation for vascular surgery due to the low incidence of perioperative events, despite a high prevalence of coronary atherosclerosis.
Findings should not alter preoperative imaging strategies in vascular surgery; hypothesis-generating for imaging utility in low-event settings.
BACKGROUND AND OBJECTIVES: Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation. SUBJECTS AND METHODS: Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month. RESULTS: Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction. CONCLUSION: We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.
No takes yet. Share an insight, caveat, or question.
Chang et al. (2014) conducted an observational in Scheduled for elective vascular surgery (n=91). Stress perfusion CT with CCTA was evaluated on Perioperative cardiac events within 1 month after surgery. Preoperative stress perfusion CT with CCTA in patients scheduled for vascular surgery identified significant coronary artery stenosis in 39.6% and perfusion defects in 13.2%, but did not predict the low rate (4.4%) of perioperative cardiac events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: