title: Value of coronary computed tomography angiography in ruling out coronary artery disease before intermediate- and high-risk non-cardiac surgery.
abstract: OBJECTIVE
  To assess the value of preoperative coronary computed tomographic angiography (CCTA) in the detection of coronary artery disease (CAD) in patients planned to undergo non-cardiac surgery at intermediate or high risk to avoid unnecessary invasive coronary angiography (ICA).
  
  
  METHODS
  The study protocol was approved by our institutional review board and informed consent was given. In this prospective study, 157 consecutive patients who underwent CCTA before undergoing non-cardiac surgery at intermediate or high risk was involved. The non-cardiac surgery included high-risk surgery (17 patients) and intermediate-risk surgery (140 patients). Follow-up was performed in 6-11 months to define cardiac events described as acute coronary syndrome (ACS) or death secondary to ASC, arrhythmias, cardiac revascularization, or cardiac failure. χ(2) test was performed to compare the differences in incidence of cardiac events among patients who had undergone or who had not undergone preoperative ICA.
  
  
  RESULTS
  CCTA was of diagnostic value in 145 of 157 patients. Thirty-seven of 145 had no CAD, and 88 of 145 had no significant CAD (<50% stenosis), and non-cardiac surgery was performed in them without preoperative ICA. No patients in those patients had postoperative ischemic events at follow-up; 20 had significant CAD (≥50% stenosis) and underwent surgery after preoperative ICA. CCTA was non-diagnostic in 12 patients who were referred for preoperative ICA, and 4 of 12 underwent surgery after PCI or CABG. There were no differences in cardiac events between patients who had undergone preoperative ICA and those who had not (P=0.45).
  
  
  CONCLUSIONS
  In patients with planned non-cardiac surgery at medium or high risk of cardiovascular events, preoperative CCTA is an effective diagnostic tool for detecting CAD. Preoperative ICA can be safely avoided in patients with normal findings or with stenosis<50% in CCTA.
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China; Department of Radiology,3Department of Endocrinology,Navy General Hospital of PLA,Beijing 100048,China.
authors.forename: Shu-ping
authors.initials: SP
authors.lastname: Tian
authors.affiliation: Department of Endocrinology,Navy General Hospital of PLA,Beijing 100048,China.
authors.forename: Chun-ping
authors.initials: CP
authors.lastname: Li
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Ying-Na
authors.initials: YN
authors.lastname: Li
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Lu
authors.initials: L
authors.lastname: Gan
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Rui-ping
authors.initials: RP
authors.lastname: Chang
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Hai-yue
authors.initials: HY
authors.lastname: Ju
authors.affiliation: Department of Radiology,General Hospital of PLA,Beijing 100853,China.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*