title: Ruling out coronary artery disease with noninvasive coronary multidetector CT angiography before noncoronary cardiovascular surgery.
abstract: OBJECTIVE
  To assess the usefulness of preoperative coronary computed tomographic (CT) angiography in the detection of coronary artery disease (CAD) in nonselected patients scheduled to undergo noncoronary cardiovascular surgery to avoid unnecessary invasive coronary angiography (ICA).
  
  
  METHODS
  The institutional review board approved the study protocol; informed consent was given. This prospective study involved 161 consecutive patients who underwent coronary calcium scoring and coronary CT angiography before undergoing noncoronary cardiovascular surgery. Seven patients were excluded because of contraindications to CT angiography. The major indication of noncoronary cardiovascular surgery was valvular heart disease (121 patients). Follow-up was performed at a median of 20 months to define ischemic events described as acute coronary syndrome or death secondary to acute coronary syndrome, arrhythmias, or cardiac failure. Multivariate analysis was performed to determine predictors of nondiagnostic coronary CT angiography. Kaplan-Meier analysis was performed to evaluate outcome at follow-up.
  
  
  RESULTS
  Twenty-one patients did not undergo surgery, which left 133 patients as the study group. Atrial fibrillation was present in 45 of 133 patients. The interquartile range of the Agatston coronary calcium score was 0-471. Coronary CT angiography was diagnostic in 108 of 133 patients. Of these, 93 of 108 had no significant CAD (≤ 50% stenosis), and noncoronary cardiovascular surgery was performed in them without preoperative ICA. No patients in this group had postoperative ischemic events at follow-up. Coronary CT angiography was nondiagnostic in 25 of 133 patients who were referred for preoperative ICA. Multivariate analysis showed Agatston score to be the only independent predictor of nondiagnostic coronary CT angiography (odds ratio = 1.002; 95% confidence interval: 1.001, 1.003; P = .001). The best Agatston score cutoff for diagnostic coronary CT angiography was 579.
  
  
  CONCLUSIONS
  In nonselected patients scheduled to undergo noncoronary cardiovascular surgery, preoperative coronary CT angiography was diagnostic in 81% of cases. Preoperative ICA could be safely avoided in patients without significant CAD by using coronary CT angiography. The Agatston score, but not the presence of atrial fibrillation, was an independent predictor of nondiagnostic coronary CT angiography.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100384/-/DC1.
authors.affiliation: Cardiac Imaging Unit, Department of Cardiovascular Surgery and Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Clínica Creu Blanca, Reina Elisenda de Montcada 17, Barcelona 08034, Spain. pcatalan@creu-blanca.es
authors.forename: Paz
authors.initials: P
authors.lastname: Catalán
authors.forename: Rubén
authors.initials: R
authors.lastname: Leta
authors.forename: Alberto
authors.initials: A
authors.lastname: Hidalgo
authors.forename: José
authors.initials: J
authors.lastname: Montiel
authors.forename: Xavier
authors.initials: X
authors.lastname: Alomar
authors.forename: David
authors.initials: D
authors.lastname: Viladés
authors.forename: Antonio
authors.initials: A
authors.lastname: Barros
authors.forename: Sandra
authors.initials: S
authors.lastname: Pujadas
authors.forename: Francesc
authors.initials: F
authors.lastname: Carreras
authors.forename: Josep M
authors.initials: JM
authors.lastname: Padró
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Guillem
authors.initials: G
authors.lastname: Pons-Lladó
mesh_terms: D000368:Aged; D013504:Cardiovascular Surgical Procedures; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D010092:Oximetry; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C093233:iobitridol; D007472:Iohexol