title: Risk stratification using computed tomography coronary angiography in patients undergoing intermediate-risk noncardiac surgery.
abstract: OBJECTIVE
  This study evaluated whether coronary artery calcium scores (CACS) and the degree of stenosis that were measured with computed tomography coronary angiography (CTCA) predicted post-operative cardiovascular events in patients who were undergoing intermediate-risk noncardiac surgery.
  
  
  BACKGROUND
  Cardiovascular complications are important causes of mortality and morbidity in patients undergoing major noncardiac surgeries.
  
  
  METHODS
  A total of 239 patients underwent CTCA before intermediate-risk noncardiac surgeries. We measured CACS and the degree of stenosis with CTCA and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores. Post-operative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, ventricular arrhythmia with hemodynamic compromise, and complete heart block.
  
  
  RESULTS
  Nineteen patients (8%) had post-operative cardiac events. The variables that correlated with the occurrence of cardiac events were RCRI (p < 0.001), CACS (p < 0.001), the presence of significant coronary artery stenosis (diameter stenosis ≥50%) (p = 0.01), and multivessel coronary artery disease (p < 0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 113 (sensitivity, 0.79; specificity, 0.61; area under the curve, 0.762). When comparing ROC curves of the combination models of RCRI, high CACS (≥113), and the presence of multivessel disease, RCRI plus high CACS, RCRI plus multivessel disease, and RCRI plus high CACS plus multivessel disease were significantly more predictable of post-operative cardiovascular events than RCRI alone.
  
  
  CONCLUSIONS
  In the pre-operative risk stratification of patients who were undergoing intermediate-risk noncardiac surgeries, CTCA evaluations showed additive value to RCRI.
authors: Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors: Jong-Hwa
authors: JH
authors: Ahn
authors: Jeong Rang
authors: JR
authors: Park
authors: Ji Hyun
authors: JH
authors: Min
authors: Ju-Tae
authors: JT
authors: Sohn
authors: Seok-Jae
authors: SJ
authors: Hwang
authors: Yongwhi
authors: Y
authors: Park
authors: Jin-Sin
authors: JS
authors: Koh
authors: Young-Hoon
authors: YH
authors: Jeong
authors: Choong Hwan
authors: CH
authors: Kwak
authors: Jin-Yong
authors: JY
authors: Hwang
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000706:statistics & numerical data; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*