Objective Myocardial scintigraphy and/or conventional angiography (CA) are often performed before cardiac surgery in attempt to identify unsuspected coronary artery disease which might result in significant cardiac morbidity and mortality. Multidetector CT coronary angiography (MDCTCA) has a recognised high negative predictive value and may provide a noninvasive alternative in this subset of patients. The aim of this study was to evaluate the clinical value of MDCTCA as a preoperative screening test in patients candidates for noncoronary cardiac surgery.
Methods One hundred and thirty-two patients underwent MDCTCA (Somatom Sensation 16 Cardiac, Siemens) in the assessment of the cardiac risk profile before surgery. Coronary arteries were screened for iÝ 50% stenosis. Patients without significant stenosis (Group 1) underwent surgery without any adjunctive screening tests while all patients with coronary lesions iÝ 50% at MDCTCA (Group 2) underwent CA.
Results Sixteen patients (12.1%) were excluded due to poor image quality. Seventy-two patients without significant coronary stenosis at MDCTCA were submitted to surgery. Thirty out of 36 patients with significant (iÝ 50%) coronary stenosis at MDCTCA and CA underwent adjunctive by-pass surgery or coronary angioplasty. In 8 patients, MDCTCA overestimated the severity of the coronary lesions (>50% MDCTCA, <50% CA). No severe cardiovascular peri-operative events such as myocardial ischemia, myocardial infarction or cardiac failure occurred in any patient in Group 1.
Conclusions MDCTCA seems to be effective as a preoperative screening test prior to noncoronary cardiac surgery. In this era of cost containment and optimal care of patients, MDCTCA is able to provide coronary vessel and ventricular function evaluation and may become the method of choice for the assessment of a cardiovascular risk profile prior to major surgery.
- CT coronary angiography
- cardiac surgery
- pre-operative risk assessment
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