Key result
A preoperative coronary artery calcification score ≥7 predicted postoperative cardiac complications with 100% sensitivity, 71% specificity, 23% positive predictive value, and 100% negative predictive value.
Why the study?
Does the presence of coronary artery calcification on preoperative CT predict postoperative cardiac complications in patients undergoing noncardiac thoracic surgery?
Observational (n=75)
No
Does the presence of coronary artery calcification on preoperative CT predict postoperative cardiac complications in patients undergoing noncardiac thoracic surgery?
Effect estimate: Sensitivity 100%, Specificity 71%, PPV 23%, NPV 100%
The absence of coronary artery calcification on preoperative CT is a highly reliable predictor (100% negative predictive value) of a favorable postoperative cardiac course in patients undergoing noncardiac thoracic surgery.
Hypothesis-generating for preoperative CAC scoring in thoracic surgery risk stratification; prospective validation needed before clinical adoption.
PURPOSE: Our goal was to determine the predictive value of coronary artery calcification (CAC) on preoperative CT of the thorax for cardiac complications of noncardiac thoracic surgery. METHOD: Of 117 patients undergoing noncardiac thoracic surgical procedures between January 1, 1993, and June 1, 1995, at our institution, 75 had inpatient records and chest CTs available for retrospective review. Inpatient records were reviewed for postoperative cardiac complications (arrhythmia, hypotension with ECG changes, myocardial infarction, congestive heart failure, stroke, and death). The CT scans were scored for the presence and extent of CAC by an independent observer. RESULTS: Six of the 75 patients had cardiac complications including 1 death. Thirty-nine of the 75 patients had a CAC score of > or = 7. The sensitivity, specificity, positive predictive value, and negative predictive value of a CAC score of > or = 7 for cardiac complications were 100, 71, 23, and 100%, respectively. CONCLUSION: The presence of CAC on preoperative CT scanning is associated with cardiac complications of noncardiac thoracic surgery; however, the positive predictive value is low. The absence of CAC was a reliable predictor of a favorable postoperative cardiac course.
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Roth et al. (1997) conducted an observational in Noncardiac thoracic surgery (n=75). Coronary artery calcification (CAC) score ≥7 on preoperative CT vs. CAC score <7 was evaluated on Postoperative cardiac complications (arrhythmia, hypotension with ECG changes, myocardial infarction, congestive heart failure, stroke, and death) (Sensitivity 100%, Specificity 71%, PPV 23%, NPV 100%). A preoperative coronary artery calcification score ≥7 predicted postoperative cardiac complications with 100% sensitivity, 71% specificity, 23% positive predictive value, and 100% negative predictive value.
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