title: Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography.
abstract: BACKGROUND
  The appropriate indication for coronary computed tomographic angiography (CTA) as a part of preoperative evaluation has not been defined yet. We investigated the value of coronary CTA in patients undergoing noncardiac surgery.
  
  
  RESULTS
  We included 844 patients (median age, 67 years; male sex, 62%) who underwent coronary CTA for screening of coronary artery disease before noncardiac surgery. Clinically determined revised cardiac risk index were compared with the extent and severity of coronary artery disease assessed by coronary CTA. Perioperative major cardiac event (PMCE), defined as cardiac death, myocardial infarction, or pulmonary edema within postoperative 30 days, developed in 25 patients (3.0%). Significant coronary CTA finding was defined as >3 any lesions with ≥1 (diameter stenosis ≥70%) stenosis based on the relationship between the severity of coronary artery disease and PMCE risk. The risk of PMCE was 14.0% in patients with significant CTA findings, whereas 2.2% of patients without significant CTA findings regardless of revised cardiac risk index score. The predictive performance of revised cardiac risk index could be improved significantly after addition of significant coronary CTA findings (c-statistics=0.631 versus 0.757; net reclassification improvement=0.923; integrated discrimination improvement=0.051). On the basis of revised cardiac risk index and coronary CTA, the risk of PMCE could be estimated with sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 73%, 8%, and 99%, respectively.
  
  
  CONCLUSIONS
  Addition of coronary CTA to clinical risk improved perioperative risk stratification. Absence of significant coronary CTA findings conferred low PMCE risk with high specificity and negative predictive value regardless of clinical risk. Coronary CTA may improve perioperative risk stratification in patients undergoing noncardiac surgery.
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Ji-won
authors.initials: JW
authors.lastname: Hwang
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Sung-A
authors.initials: SA
authors.lastname: Chang
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Sung-Mok
authors.initials: SM
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.). jhchoimd@gmail.com.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011654:Pulmonary Edema / Q000209:etiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: computed tomography; coronary artery disease; perioperative care