Abstract
Purpose
The aim of our work was to assess the role of dual-source computed tomography (DSCT) in the preoperative evaluation of coronary artery disease in patients scheduled for noncoronary cardiac surgery.
Materials and methods
One hundred patients were prospectively evaluated. Patients negative for coronary disease at DSCT (n=81) underwent surgery without coronary angiography. Patients positive for significant lesions or with nondiagnostic image quality due to artefacts or severe calcifications underwent coronary angiography (n=19) and were excluded from the study. In patients who underwent surgery with only a DSCT diagnosis, we evaluated the frequency of major adverse cardiac events (MACEs) during the perioperative period and at 3 months follow-up.
Results
No MACEs were recorded during the perioperative period; three noncardiac complications (one surgical revision for bleeding, one cardiac tamponade and one respiratory insufficiency) and one death related to severe respiratory insufficiency were observed. None of the 80 patients had MACEs during the 3-month follow-up period.
Conclusions
Coronary evaluation with DSCT is able to rule out the presence of coronary disease in patients scheduled for cardiac surgery, without the need for coronary angiography confirmation. Patients with significant stenosis or nondiagnostic image quality should be referred for coronary angiography.
Riassunto
Obiettivo
Lo scopo di questo lavoro è analizzare il ruolo dell’angiografia coronarica mediante tomografia computerizzata Dual Source (TCDS) nella valutazione preoperatoria del rischio cardiovascolare in pazienti che devono essere sottoposti ad intervento di cardiochirurgia non coronarica.
Materiali e metodi
Sono stati studiati prospetticamente 100 pazienti candidati ad intervento di chirurgia cardiaca non coronarica e sottoposti ad angiografia mediante TCDS. I pazienti risultati negativi sono stati inviati direttamente all’intervento chirurgico (n=81); i pazienti positivi per stenosi significative o in cui la qualità delle immagini risultava non diagnostica sono stati sottoposti ad angiografia coronarica invasiva (n=19) ed esclusi dallo studio. Nei pazienti operati e studiati solo con TCDS è stata valutata la frequenza di eventi cardiaci avversi maggiori (ECAM) peri-operatoria e ad un follow-up di 3 mesi.
Risultati
Nel periodo peri-operatorio non sono stati osservati ECAM e si sono registrate 3 complicanze non cardiache quali una revisione chirurgica per sanguinamento, una mediastinite ed una insufficienza respiratoria; in tale periodo si è verificato un solo decesso per cause non cardiache correlato ad una severa insufficienza respiratoria. In nessuno dei restanti 80 pazienti si sono osservati ECAM ad un follow-up di 3 mesi.
Conclusioni
Lo studio coronarico mediante TCDS permette di escludere la presenza di malattia ateromasica significativa nei pazienti che devono essere sottoposti ad interventi di cardiochirurgia non coronarica e non necessita di una conferma tramite angiografia invasiva, se lo studio presenta una qualità d’immagine diagnostica. Nei pazienti in cui si osservano stenosi significative o non è possibile la valutazione di tutti i segmenti è necessaria l’esecuzione di una coronarografia.
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Buffa, V., De Cecco, C., Cossu, L. et al. Preoperative coronary risk assessment with dual-source CT in patients undergoing noncoronary cardiac surgery. Radiol med 115, 1028–1037 (2010). https://doi.org/10.1007/s11547-010-0543-y
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DOI: https://doi.org/10.1007/s11547-010-0543-y
Keywords
- Dual-source computed tomography
- Coronary disease
- Cardiac surgery
- Major adverse cardiac events
- Coronary angiography