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Coronary CTA for Preoperative Risk Assessment in Noncardiac Surgery

  • Cardiac Computed Tomography (M Cheezum and B Chow, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Risk assessment for ischemic cardiac complications post noncardiac surgery is not an exact science. This often prompts physicians to order investigations for further risk stratification. As a diagnostic text coronary CT angiography (CCTA)* could prove to be a useful adjunct in preoperative risk assessment and its utility in this setting will be considered.

Recent Findings

CCTA has been used to assess preoperative risk in several clinical studies, including the recent CTA VISION trial. CTA VISION suggested, in the cohort examined, that CCTA could lead to an exaggeration of preoperative risk. Whether this is true in other populations will be considered.

Summary

In this review, the results from CTA VISION and the recently published Canadian Cardiovascular Society guidelines will be considered in the context of previous literature and current international guidelines.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383–431.

    Article  PubMed  Google Scholar 

  2. Cohen MC, Aretz TH. Histological analysis of coronary artery lesions in fatal postoperative myocardial infarction. Cardiovasc Pathol. 1999 May;8(3):133–9.

    Article  PubMed  CAS  Google Scholar 

  3. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77–137.

    Article  PubMed  Google Scholar 

  4. •• Sheth T, Chan M, Butler C, Chow B, Tandon V, Nagele P, et al. Prognostic capabilities of coronary computed tomographic angiography before non-cardiac surgery: prospective cohort study. BMJ. 2015;350:h1907. Scientifically robust paper examining the role of CCTA in NCS in comparison to RCRI: likely to set the standard for subsequent papers on this topic.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can J Cardiol. 2017;33(1):17–32.

    Article  PubMed  Google Scholar 

  6. Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173(6):627–34.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Chow BJ, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A, et al. Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol. 2010;55(10):1017–28.

    Article  PubMed  Google Scholar 

  8. • Shalaeva EV, Saner H, Janabaev BB, Shalaeva AV. Coronary artery calcium score and coronary computed tomographic angiography for major perioperative cardiovascular complications in symptomatic diabetic patients undergoing trans-femoral amputation. Int J Cardiol. 2016;221:806–11. High-risk patient studies demonstrated high-predictive value of CCTA to predict postoperative cardiac events.

    Article  PubMed  Google Scholar 

  9. Biccard BM, Rodseth RN. The pathophysiology of peri-operative myocardial infarction. Anaesthesia. 2010;65(7):733–41.

    Article  PubMed  CAS  Google Scholar 

  10. Wirthlin DJ, Cambria RP. Surgery-specific considerations in the cardiac patient undergoing noncardiac surgery. Prog Cardiovasc Dis. 1998 Mar;40(5):453–68.

    Article  PubMed  CAS  Google Scholar 

  11. Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med. 2010;152(1):26–35.

    Article  PubMed  Google Scholar 

  12. Dawood MM, Gutpa DK, Southern J, Walia A, Atkinson JB, Eagle KA. Pathology of fatal perioperative myocardial infarction: implications regarding pathophysiology and prevention. Int J Cardiol. 1996;57(1):37–44.

    Article  PubMed  CAS  Google Scholar 

  13. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60(16):1581–98.

    Article  PubMed  Google Scholar 

  14. Kong YG, Kang JW, Kim YK, Seo H, Lim TH, Hwang S, et al. Preoperative coronary calcium score is predictive of early postoperative cardiovascular complications in liver transplant recipients. Br J Anaesth. 2015;114(3):437–43.

    Article  PubMed  CAS  Google Scholar 

  15. Ahn JH, Park JR, Min JH, Sohn JT, Hwang SJ, Park Y, et al. Risk stratification using computed tomography coronary angiography in patients undergoing intermediate-risk noncardiac surgery. J Am Coll Cardiol. 2013;61(6):661–8.

    Article  PubMed  Google Scholar 

  16. Hwang JW, Kim EK, Yang JH, Chang SA, Song YB, Hahn JY, et al. Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography. Circ Cardiovasc Imaging. 2015;8(3):e002582.

    Article  PubMed  Google Scholar 

  17. Jodocy D, Abbrederis S, Graziadei IW, Vogel W, Pachinger O, Feuchtner GM, et al. Coronary computer tomographic angiography for preoperative risk stratification in patients undergoing liver transplantation. Eur J Radiol. 2012;81(9):2260–4.

    Article  PubMed  Google Scholar 

  18. Chang SA, Kim SM, Choi SH, Choe YH, Kim YW, Kim DK. Clinical utility of coronary CT angiography with stress perfusion CT in preoperative cardiac risk evaluation. Korean Circ J. 2014;44(3):170–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hecht HS. Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging. 2015;8(5):579–96.

    Article  PubMed  Google Scholar 

  21. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. Circulation. 2009;119(22):e561–87.

    Article  PubMed  Google Scholar 

  22. Hecht HS, Cronin P, Blaha MJ, Budoff MJ, Kazerooni EA, Narula J, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: a report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Thorac Imaging. 2017;32(5):W54–66.

    Article  PubMed  Google Scholar 

  23. Azour L, Kadoch MA, Ward TJ, Eber CD, Jacobi AH. Estimation of cardiovascular risk on routine chest CT: ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges. J Cardiovasc Comput Tomogr. 2017;11(1):8–15.

    Article  PubMed  Google Scholar 

  24. Labounty TM, Eagle KA. Coronary computed tomographic angiography for preoperative risk: improved area under curve is not enough. Circ Cardiovasc Imaging. 2015;8(3):e003157.

    Article  PubMed  Google Scholar 

  25. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795–804.

    Article  PubMed  CAS  Google Scholar 

  26. Garcia S, Moritz TE, Ward HB, Pierpont G, Goldman S, Larsen GC, et al. Usefulness of revascularization of patients with multivessel coronary artery disease before elective vascular surgery for abdominal aortic and peripheral occlusive disease. Am J Cardiol. 2008;102(7):809–13.

    Article  PubMed  Google Scholar 

  27. Monaco M, Stassano P, Di TL, Pepino P, Giordano A, Pinna GB, et al. Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study. J Am Coll Cardiol. 2009;54(11):989–96.

    Article  PubMed  Google Scholar 

  28. Illuminati G, Ricco JB, Greco C, Mangieri E, Calio' F, Ceccanei G, et al. Systematic preoperative coronary angiography and stenting improves postoperative results of carotid endarterectomy in patients with asymptomatic coronary artery disease: a randomised controlled trial. Eur J Vasc Endovasc Surg. 2010;39(2):139–45.

    Article  PubMed  CAS  Google Scholar 

  29. Wong EY, Lawrence HP, Wong DT. The effects of prophylactic coronary revascularization or medical management on patient outcomes after noncardiac surgery—a meta-analysis. Can J Anaesth. 2007;54(9):705–17.

    Article  PubMed  Google Scholar 

  30. Duceppe E, Yusuf S, Tandon V, Rodseth R, Biccard BM, Xavier D, et al. Design of a randomized placebo-controlled trial to assess dabigatran and omeprazole in patients with myocardial injury after noncardiac surgery (MANAGE). Can J Cardiol. 2018;34(3):295–302.

    Article  PubMed  Google Scholar 

  31. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107(23):2900–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

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Correspondence to Gary R. Small.

Ethics declarations

All reported studies/experiments with humans or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

Conflict of Interest

Benjamin JW Chow reports grants from CV Diagnostix, other from GE, and non-financial support from TeraRecon, outside the submitted work. The other authors do not have any conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Cardiac Computed Tomography

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Small, G.R., Ernst, J., Gauthier, N. et al. Coronary CTA for Preoperative Risk Assessment in Noncardiac Surgery. Curr Cardiovasc Imaging Rep 11, 21 (2018). https://doi.org/10.1007/s12410-018-9461-5

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  • DOI: https://doi.org/10.1007/s12410-018-9461-5

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