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Computed tomographic coronary angiography in patients with surgically treated type A aortic dissection: preliminary results

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Abstract

Acute type A aortic dissection is a serious emergency with a mortality rate of up to 40% within the first 24 h when left untreated. Surgical therapy needs to be initiated promptly. Due to this urgent situation, preoperative evaluation of the coronary arteries is not routinely performed in these patients. The aim of this study was to evaluate the accuracy of 64-slice computed tomography angiography (CTA) for postoperative coronary artery assessment in these patients. Ten consecutive patients with two or more cardiovascular risk factors were prospectively enrolled. Patients had type A aortic dissection treated surgically with a supracoronary graft of the ascending aorta. Performance of CTA to exclude significant stenosis (>50% lumen narrowing) and/or coronary artery dissection was compared with quantitative coronary angiography. A total of 147 segments were evaluated. Three segments (2%) were excluded from analysis. CTA correctly assessed one of three significant stenoses in three patients and correctly excluded coronary artery disease (CAD) in six of ten patients. One patient was rated false positive. Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT for identifying coronary artery disease by segment was 98%, 33%, 99%, 50%, and 99%, respectively (P < 0.05). By patient, it was 70%, 33%, 86%, 50%, and 75%, respectively. No coronary artery dissection was found. Noninvasive CTA may be a viable alternative to conventional angiography for postoperative coronary artery evaluation in patients with surgically treated type A aortic dissection and cardiovascular risk factors. An NPV of 99% should allow for reliable exclusion of CAD. Further studies with higher patient numbers are warranted.

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Authors and Affiliations

  1. Radiology, Bern University Hospital, Bern, Switzerland

    Andrea B. Rosskopf, Rahel Bugmann, Daniel Ott & Hanno Hoppe

  2. Department of Cardiac Surgery, Bern University Hospital (Inselspital), Freiburgstrasse, 3010, Bern, Switzerland

    Volkhard Goeber & Thierry Carrel

  3. Cardiology, Bern University Hospital, Bern, Switzerland

    Otto Hess

Authors
  1. Andrea B. Rosskopf
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  2. Rahel Bugmann
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  3. Volkhard Goeber
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  4. Daniel Ott
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  5. Otto Hess
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  6. Thierry Carrel
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  7. Hanno Hoppe
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Correspondence to Volkhard Goeber.

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Rosskopf, A.B., Bugmann, R., Goeber, V. et al. Computed tomographic coronary angiography in patients with surgically treated type A aortic dissection: preliminary results. Emerg Radiol 17, 185–190 (2010). https://doi.org/10.1007/s10140-009-0829-3

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  • DOI: https://doi.org/10.1007/s10140-009-0829-3

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