Computed tomography and scintigraphy vs. cardiac catheterization for coronary disease screening prior to noncardiac surgery.
OBJECTIVE
The goal of this study was to investigate the utility of multidetector-row computed tomography (MDCT) and adenosine triphosphate stress cardiac single photon emission computed tomography (ATP-SPECT) in evaluating coronary artery disease (CAD) in patients scheduled for non-cardiac surgery.


METHODS
We routinely performed echocardiography and exercise stress electrocardiography as preoperative cardiac screening examinations for patients scheduled for non-cardiac surgery under general anesthesia. Of 848 consecutive preoperative patients (Non-invasive Group), 49 patients with abnormalities of these screening examinations had MDCT and ATP-SPECT. Of 809 consecutive preoperative patients studied at an earlier time (Invasive Group), 58 patients with abnormalities of these screening examinations had cardiac catheterization as an additional cardiac examination.


RESULTS
The number of patients in the non-invasive and invasive subgroups having additional screening examinations was comparable, and there was no significant difference in perioperative cardiac events between the two subgroups. Based on results of the additional tests in the two subgroups, preoperative prophylactic invasive treatment for CAD was carried out in a small number of patients, again with no significant differences between the groups. However, total medical expenses for the additional cardiac examinations were significantly reduced in the non-invasive subgroup compared with the invasive subgroup (140,030+/-34,800 vs. 187,170+/-26,120 yen, respectively, p=0.0002).


CONCLUSIONS
Non-invasive examination prior to noncardiac surgery using MDCT and ATP-SPECT in a subgroup of patients suspected of having CAD appears to be a useful screening procedure. Compared with invasive cardiac catheterization, CT testing has comparable diagnostic utility without an increase in perioperative cardiac events, and in addition, it has an improved cost-benefit profile.
Kaneko
Kazuyoshi
K
Department of Internal Medicine, Municipal Sakata Hospital, Sakata, Japan. kzkaneko@nihonkai-hos.jp
Ito
Makoto
M
Takanashi
Toshiyasu
T
Hashizume
Eiji
E
Owashi
Kazuya
K
Kaneko
Hisashi
H
Ide
Yoshihiro
Y
Oguma
Masaki
M
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000191:economics; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis / Q000379:methods; D004452:Echocardiography / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods