Key result
Routine preoperative noncontrast chest CT screening prior to cardiac surgery did not reduce the incidence of perioperative stroke compared with standard of care alone.
Why the study?
To evaluate if routine screening for aortic calcification using unenhanced CT lowers the risk of stroke and alters the surgical approach in patients undergoing general cardiac surgery compared with standard of care.
Does routine preoperative screening for aortic calcifications using noncontrast CT reduce the risk of stroke in adult patients undergoing general cardiac surgery?
RCT (n=862)
Open-label
1:1
Yes
Does routine preoperative screening for aortic calcifications using noncontrast CT reduce the risk of stroke in adult patients undergoing general cardiac surgery?
Routine preoperative noncontrast CT screening for aortic calcification in cardiac surgery candidates does not reduce perioperative stroke rates or significantly alter surgical approaches compared to standard of care.
Answers are grounded in this paper and cite their sources.
Does not support routine preoperative CT screening for aortic calcifications; challenges assumptions favoring its adoption in cardiac surgery.
OBJECTIVES: To evaluate if routine screening for aortic calcification using unenhanced CT lowers the risk of stroke and alters the surgical approach in patients undergoing general cardiac surgery compared with standard of care (SoC). METHODS: In this prospective, multicenter, randomized controlled trial, adult patients scheduled for cardiac surgery from September 2014 to October 2019 were randomized 1:1 into two groups: SoC alone, including chest radiography, vs. SoC plus preoperative noncontrast CT. The primary endpoint was in-hospital perioperative stroke. Secondary endpoints were preoperative change of the surgical approach, in-hospital mortality, and postoperative delirium. The trial was halted halfway for expected futility, as the conditional power analysis showed a chance < 1% of finding the hypothesized effect. RESULTS: A total of 862 patients were evaluated (SoC-group: 433 patients (66 ± 11 years; 74.1% male) vs. SoC + CT-group: 429 patients (66 ± 10 years; 69.9% male)). The perioperative stroke rate (SoC + CT: 2.1%, 9/429 vs. SoC: 1.2%, 5/433, p = 0.27) and rate of changed surgical approach (SoC + CT: 4.0% (17/429) vs. SoC: 2.8% (12/433, p = 0.35) did not differ between groups. In-hospital mortality and postoperative delirium were comparable between groups. In the SoC + CT group, aortic calcification was observed on CT in the ascending aorta in 28% (108/380) and in the aortic arch in 70% (265/379). CONCLUSIONS: Preoperative noncontrast CT in cardiac surgery candidates did not influence the surgical approach nor the incidence of perioperative stroke compared with standard of care. Aortic calcification is a frequent finding on the CT scan in these patients but results in major surgical alterations to prevent stroke in only few patients. KEY POINTS: • Aortic calcification is a frequent finding on noncontrast computed tomography prior to cardiac surgery. • Routine use of noncontrast computed tomography does not often lead to a change of the surgical approach, when compared to standard of care. • No effect was observed on perioperative stroke after cardiac surgery when using routine noncontrast computed tomography screening on top of standard of care.
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Knol et al. (2021) conducted an RCT in Elective cardiac surgery (n=862). Preoperative noncontrast chest CT plus standard of care vs. Standard of care alone (including chest radiography) was evaluated on In-hospital perioperative stroke (p=0.27). Routine preoperative noncontrast chest CT screening prior to cardiac surgery did not reduce the incidence of perioperative stroke compared with standard of care alone.
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