Usefulness of preoperative coronary computed tomography angiography in high risk non-cardiovascular surgery old patients
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RESEARCH ARTICLE
Open Access
Usefulness of preoperative coronary computed tomography angiography in high risk non‑cardiovascular surgery old patients with unknown or suspected coronary artery disease Xue‑Ming Li1†, Zhong‑Zhi Xu1†, Zhi‑Peng Wen1, Jiao Pei2, Wei Dai3, Huai‑Ming Wang4, Jing Reng1, Peng Zhou1*† and Guo‑Hui Xu1*†
Abstract Background: Cumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment. With the increasing elderly population, many patients scheduled for non-cardiovascular surgery may have concomitant coro‑ nary artery disease (CAD). The aim of this study was to investigate the usefulness of preoperative CCTA to rule out or detect significant CAD in this cohort of patients and the impact of CCTA results to clinical decision-making. Methods: 841 older patients (age 69.5 ± 5.8 years, 74.6% males) with high risk non-cardiovascular surgery includ‑ ing 771 patients with unknown CAD and 70 patients with suspected CAD who underwent preoperative CCTA were retrospectively enrolled. Multivariate logistic regression analysis was performed to determine predictors of significant CAD and the event of cancelling scheduled surgery in patients with significant CAD. Results: 677 (80.5%) patients had non-significant CAD and 164 (19.5%) patients had significant CAD. Single-, 2-, and 3- vessel disease was found in 103 (12.2%), 45 (5.4%) and 16 (1.9%) patients, respectively. Multivariate analysis dem‑ onstrated that positive ECG analysis and Agatston score were independently associated with significant CAD, and the optimal cutoff of Agatston score was 195.9. The event of cancelling scheduled surgery was increased consistently according to the severity of stenosis and number of obstructive major coronary artery. Multivariate analysis showed that the degree of stenosis was the only independent predictor for cancelling scheduled surgery. In addition, medica‑ tion using at perioperative period increased consistently according to the severity of stenosis.
*Correspondence: [email protected]; [email protected] † Xue-Ming Li, Zhong-Zhi Xu have contributed equally to this work and share the co-first author † Peng Zhou and Guo-Hui Xu have contributed equally to this work and share the co-corresponding author 1 Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu 610041, Sichuan Province, China Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
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