Risk stratification using computed tomography coronary angiography in patients undergoing intermediate-risk noncardiac surgery.


Journal Article

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 ≥50%) (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 (≥113), 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.

Full Text

Cited Authors

  • Ahn, J-H; Park, JR; Min, JH; Sohn, J-T; Hwang, S-J; Park, Y; Koh, J-S; Jeong, Y-H; Kwak, CH; Hwang, J-Y

Published Date

  • February 2013

Published In

Volume / Issue

  • 61 / 6

Start / End Page

  • 661 - 668

PubMed ID

  • 23391198

Pubmed Central ID

  • 23391198

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

International Standard Serial Number (ISSN)

  • 0735-1097

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2012.09.060


  • eng