title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology, La Cavale-Blanche Hospital, Brest University Hospital, Brest cedex, France. jean-christophe.cornily@chu-brest.fr
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Cornily
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Eric
authors.initials: E
authors.lastname: Bezon
authors.forename: Virginie
authors.initials: V
authors.lastname: Jan
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Pennec
authors.forename: Yves
authors.initials: Y
authors.lastname: Etienne
authors.forename: Ulric
authors.initials: U
authors.lastname: Vinsonneau
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Jacques
authors.initials: J
authors.lastname: Mansourati
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Blanc
authors.forename: Jacques
authors.initials: J
authors.lastname: Boschat
mesh_terms: 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