title: [Predictive value of multi-sliced computed tomography to evaluate obstructive coronary vessel, in the preoperative assessment of non-coronary cardiac surgery].
abstract: BACKGROUND
  Significant Coronary Artery Disease (CAD>50%) it can easily detected with Multislice Computed Tomography (MSCT), nevertheless if MSCT may replace Invasive Coronary Angiography (ICA) in the preoperative assessment of the patient undergoing to non-coronary cardiac surgery is not well defined. The objective of this study was to know if the MSCT can replace ICA in the preoperative valuation of patients who go to cardiac surgery
  
  
  METHODS
  64 consecutive patients in Class I recommendation of American College of Cardiology / American Heart Association (ACC/AHA) guidelines for preoperative ICA were evaluated. Patients with angina, contrast medium allergy, serum creatinine up to 2.0 mg/dL, previous coronary cardiac surgery or coronary angioplasty and supraventricular arrhythmias were excluded. Both, Coronary artery calcium (CAC) and coronary angiography were evaluated.
  
  
  RESULTS
  The prevalence of significant (>50%) CAD was 12.5%. The Sensitivity of MSCT to detect significant CAD was 87.5%, its Specificity of 92.8%, Predictive Negative Value was 98.1% and Area Under the Curve (ROC analysis) = 0.90. Anyone with Rheumatic Valvular Disease had significant CAD or CAC>400 UA (RR = 0.80, IC95% 0.69-0.94). Degenerative Aortic Valve Stenosis had a major probability of significant CAD (RR of 9.0; IC 95% 1.64-49.80). Logistic Regression Analysis showed than CAC>400 UA (Coef β 0,351, t = 4.402 p = 0.000) and male gender (Coef β 0,179, t = 2.445, p = 0.017), were the best predicting variables of CAD. This study shows different populations in patients undergoing to non-coronary cardiac surgery.
  
  
  CONCLUSIONS
  Gender, CAC> 400 UA and type of cardiac disease previously surgery may be useful for triage to MSCT or ICA in the preoperative assessment. This study shows that ICA may be necessarily indicated in some patients in assessment of non-coronary cardiac surgery but not absolutely indicated in all patients that Guidelines of ACC/AHA have recommended.
authors.affiliation: Departamento de Consulta Externa. Instituto Nacional de Cardiología Ignacio Chávez. México D.F., México.
authors.forename: Sergio
authors.initials: S
authors.lastname: Trevethan-Cravioto
authors.forename: Jorge
authors.initials: J
authors.lastname: Cossío-Aranda
authors.forename: Marco A
authors.initials: MA
authors.lastname: Martínez-Ríos
authors.forename: José A
authors.initials: JA
authors.lastname: Arias-González
authors.forename: Enrique
authors.initials: E
authors.lastname: Vallejo
authors.forename: Aloha
authors.initials: A
authors.lastname: Meave
authors.forename: Eric
authors.initials: E
authors.lastname: Kimura-Hayama
mesh_terms: D006348:Cardiac Surgical Procedures; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011300:Preoperative Care