- 作者：Jong-Hwa Ahn ; MD? ; Jeong Rang Park ; MD? ; parkjrang@gmail.com ; Ji Hyun Min ; MD? ; Ju-Tae Sohn ; MD&dagger ; ; Seok-Jae Hwang ; MD? ; Yongwhi Park ; MD? ; Jin-Sin Koh ; MD? ; Young-Hoon Jeong ; MD? ; Choong Hwan Kwak ; MD? ; Jin-Yong Hwang ; MD? ; jyhwang@nongae.gsnu.ac.kr
- 关键词：computed tomography coronary angiography ; coronary artery calcium score ; intermediate risk ; noncardiac surgery ; preoperative cardiovascular risk
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：12 February, 2013
- 年：2013
- 卷：61
- 期：6
- 页码：661-668
- 全文大小：834 K
Objectives
This study evaluated whether coronary artery calcium scores (CACS) and the degree of stenosis that were measured with computed tomography coronary angiography (CTCA) predicted post-operative cardiovascular events in patients who were undergoing intermediate-risk noncardiac surgery.Background
Cardiovascular complications are important causes of mortality and morbidity in patients undergoing major noncardiac surgeries.
Methods
A total of 239 patients underwent CTCA before intermediate-risk noncardiac surgeries. We measured CACS and the degree of stenosis with CTCA and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores. Post-operative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, ventricular arrhythmia with hemodynamic compromise, and complete heart block.
Results
Nineteen patients (8 % ) had post-operative cardiac events. The variables that correlated with the occurrence of cardiac events were RCRI (p < 0.001), CACS (p < 0.001), the presence of significant coronary artery stenosis (diameter stenosis ¡Ý50 % ) (p = 0.01), and multivessel coronary artery disease (p < 0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 113 (sensitivity, 0.79; specificity, 0.61; area under the curve, 0.762). When comparing ROC curves of the combination models of RCRI, high CACS (¡Ý113), and the presence of multivessel disease, RCRI plus high CACS, RCRI plus multivessel disease, and RCRI plus high CACS plus multivessel disease were significantly more predictable of post-operative cardiovascular events than RCRI alone.
Conclusions
In the pre-operative risk stratification of patients who were undergoing intermediate-risk noncardiac surgeries, CTCA evaluations showed additive value to RCRI.