Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography

Ji won Hwang, Eun Kyung Kim, Jung Hoon Yang, Sung A. Chang, Young B in Song, Joo Yong Hahn, Seung H yuk Choi, Hyeon Cheol Gwon, Sang Hoon Lee, Sung Mok Kim, Yeon H yeon Choe, Jae Kuen Oh, Jin Ho Choi

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The appropriate indication for coronary computed tomographic angiography (CTA) as a part of preoperative evaluation has not been defined yet. We investigated the value of coronary CTA in patients undergoing noncardiac surgery.

METHODS AND RESULTS: We included 844 patients (median age, 67 years; male sex, 62%) who underwent coronary CTA for screening of coronary artery disease before noncardiac surgery. Clinically determined revised cardiac risk index were compared with the extent and severity of coronary artery disease assessed by coronary CTA. Perioperative major cardiac event (PMCE), defined as cardiac death, myocardial infarction, or pulmonary edema within postoperative 30 days, developed in 25 patients (3.0%). Significant coronary CTA finding was defined as >3 any lesions with ≥1 (diameter stenosis ≥70%) stenosis based on the relationship between the severity of coronary artery disease and PMCE risk. The risk of PMCE was 14.0% in patients with significant CTA findings, whereas 2.2% of patients without significant CTA findings regardless of revised cardiac risk index score. The predictive performance of revised cardiac risk index could be improved significantly after addition of significant coronary CTA findings (c-statistics=0.631 versus 0.757; net reclassification improvement=0.923; integrated discrimination improvement=0.051). On the basis of revised cardiac risk index and coronary CTA, the risk of PMCE could be estimated with sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 73%, 8%, and 99%, respectively.

CONCLUSIONS: Addition of coronary CTA to clinical risk improved perioperative risk stratification. Absence of significant coronary CTA findings conferred low PMCE risk with high specificity and negative predictive value regardless of clinical risk. Coronary CTA may improve perioperative risk stratification in patients undergoing noncardiac surgery.

Original languageEnglish (US)
JournalCirculation. Cardiovascular imaging
Volume8
Issue number3
DOIs
StatePublished - Mar 1 2015

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Angiography
Coronary Artery Disease
Pathologic Constriction
Pulmonary Edema
Myocardial Infarction
Sensitivity and Specificity

Keywords

  • computed tomography
  • coronary artery disease
  • perioperative care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography. / Hwang, Ji won; Kim, Eun Kyung; Yang, Jung Hoon; Chang, Sung A.; Song, Young B in; Hahn, Joo Yong; Choi, Seung H yuk; Gwon, Hyeon Cheol; Lee, Sang Hoon; Kim, Sung Mok; Choe, Yeon H yeon; Oh, Jae Kuen; Choi, Jin Ho.

In: Circulation. Cardiovascular imaging, Vol. 8, No. 3, 01.03.2015.

Research output: Contribution to journalArticle

Hwang, JW, Kim, EK, Yang, JH, Chang, SA, Song, YBI, Hahn, JY, Choi, SHY, Gwon, HC, Lee, SH, Kim, SM, Choe, YHY, Oh, JK & Choi, JH 2015, 'Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography', Circulation. Cardiovascular imaging, vol. 8, no. 3. https://doi.org/10.1161/CIRCIMAGING.114.002582
Hwang, Ji won ; Kim, Eun Kyung ; Yang, Jung Hoon ; Chang, Sung A. ; Song, Young B in ; Hahn, Joo Yong ; Choi, Seung H yuk ; Gwon, Hyeon Cheol ; Lee, Sang Hoon ; Kim, Sung Mok ; Choe, Yeon H yeon ; Oh, Jae Kuen ; Choi, Jin Ho. / Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography. In: Circulation. Cardiovascular imaging. 2015 ; Vol. 8, No. 3.
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AU - Kim, Eun Kyung

AU - Yang, Jung Hoon

AU - Chang, Sung A.

AU - Song, Young B in

AU - Hahn, Joo Yong

AU - Choi, Seung H yuk

AU - Gwon, Hyeon Cheol

AU - Lee, Sang Hoon

AU - Kim, Sung Mok

AU - Choe, Yeon H yeon

AU - Oh, Jae Kuen

AU - Choi, Jin Ho

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AB - BACKGROUND: The appropriate indication for coronary computed tomographic angiography (CTA) as a part of preoperative evaluation has not been defined yet. We investigated the value of coronary CTA in patients undergoing noncardiac surgery.METHODS AND RESULTS: We included 844 patients (median age, 67 years; male sex, 62%) who underwent coronary CTA for screening of coronary artery disease before noncardiac surgery. Clinically determined revised cardiac risk index were compared with the extent and severity of coronary artery disease assessed by coronary CTA. Perioperative major cardiac event (PMCE), defined as cardiac death, myocardial infarction, or pulmonary edema within postoperative 30 days, developed in 25 patients (3.0%). Significant coronary CTA finding was defined as >3 any lesions with ≥1 (diameter stenosis ≥70%) stenosis based on the relationship between the severity of coronary artery disease and PMCE risk. The risk of PMCE was 14.0% in patients with significant CTA findings, whereas 2.2% of patients without significant CTA findings regardless of revised cardiac risk index score. The predictive performance of revised cardiac risk index could be improved significantly after addition of significant coronary CTA findings (c-statistics=0.631 versus 0.757; net reclassification improvement=0.923; integrated discrimination improvement=0.051). On the basis of revised cardiac risk index and coronary CTA, the risk of PMCE could be estimated with sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 73%, 8%, and 99%, respectively.CONCLUSIONS: Addition of coronary CTA to clinical risk improved perioperative risk stratification. Absence of significant coronary CTA findings conferred low PMCE risk with high specificity and negative predictive value regardless of clinical risk. Coronary CTA may improve perioperative risk stratification in patients undergoing noncardiac surgery.

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