Cardiac multislice spiral computed tomography as an alternative to coronary angiography in the preoperative assessment of coronary artery disease before aortic valve surgery: a management outcome study.
BACKGROUND
Conventional coronary angiography (CA) is still recommended before valvular surgery. Preliminary studies suggest that multislice spiral computed tomography coronary angiography (MSCT-CA) can be used to rule out coronary artery disease (CAD).


OBJECTIVE
To assess prospectively the safety of ruling out CAD before surgery solely on the basis of normal MSCT-CA in patients with severe aortic valve disease.


METHODS
We included all consecutive patients scheduled for aortic valve surgery. We first estimated the calcium score (Agatston score equivalent [ASE]). Patients underwent injected MSCT if the ASE was<1000. CA was cancelled when MSCT-CA quality was sufficient and showed no significant CAD. Our primary endpoint was the occurrence of perioperative myocardial infarction in patients who underwent surgery with no prior CA.


RESULTS
Between 1st July 2005 and 30th June 2008, we included 199 patients with severe aortic valve disease: 118 men (59%); mean age 69+/-12 years; 63 patients (32%) underwent CA directly because the ASE was > or =1000. Of 136 patients who underwent MSCT-CA, 106 (78%) had a normal MSCT-CA and underwent aortic valve surgery without prior CA; CA was performed in 30 patients because of abnormal (n=18) or bad quality (n=12) MSCT-CA. One patient of the 106 (0.94%, 95% confidence interval 0.17-5.15) had a perioperative myocardial infarction.


CONCLUSIONS
When the ASE is <1000, MSCT is safe and may be recommended instead of CA as a first-line means of ruling out CAD in patients with severe aortic valve disease.
Cornily
Jean-Christophe
JC
Department of Cardiology, La Cavale-Blanche Hospital, Brest University Hospital, Brest cedex, France. jean-christophe.cornily@chu-brest.fr
Gilard
Martine
M
Bezon
Eric
E
Jan
Virginie
V
Pennec
Pierre-Yves
PY
Etienne
Yves
Y
Vinsonneau
Ulric
U
Le Gal
Grégoire
G
Mansourati
Jacques
J
Blanc
Jean-Jacques
JJ
Boschat
Jacques
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000453:epidemiology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000601:surgery; D002648:Child; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D036542:Tomography, Spiral Computed; D055815:Young Adult