Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20692
Title: Computed tomographic coronary angiography in risk stratification prior to non-cardiac surgery: a systematic review and meta-analysis.
Authors: Koshy, Anoop N;Ha, Francis Jonathan;Gow, Paul J;Han, Hui-Chen;Amirul-Islam, F M;Lim, Han S;Teh, Andrew W;Farouque, Omar
Affiliation: Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Austin Health Clinical School, The University of Melbourne, Heidelberg, Victoria, Australia
Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 24-Apr-2019
EDate: 2019-04-24
Citation: Heart 2019; online first: 24 April
Abstract: Utility of CT coronary angiography (CTA) and coronary artery calcium (CAC) scoring in risk stratification prior to non-cardiac surgery is unclear. Although current guidelines recommend stress testing in intermediate-high risk individuals, over one-third of perioperative major adverse cardiovascular events (MACE) occur in patients with a negative study. This systematic review and meta-analysis evaluates the value of CTA and CAC score in preoperative risk prognostication prior to non-cardiac surgery. MEDLINE, PubMed and EMBASE databases were searched for articles published up to June 2018. Summary ORs for degree of coronary artery disease (CAD) and perioperative MACE were pooled using a random-effects model. Eleven studies were included. Two hundred and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%; non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive multivessel 23.1%, p<0.001). Multivessel disease (MVD) demonstrated the greatest risk (OR 8.9, 95% CI 5.1 to 15.3, p<0.001). Increasing CAC score was associated with higher perioperative MACE (CAC score: ≥100 OR 5.1, ≥1000 OR 10.4, both p<0.01). In a cohort deemed high risk by established clinical indices, absence of MVD on CTA demonstrated a negative predictive value of 96% (95% CI 92.8 to 98.4) for predicting freedom from MACE. Severity and extent of CAD on CTA conferred incremental risk for perioperative MACE in patients undergoing non-cardiac surgery. The 'rule-out' capability of CTA is comparable to other non-invasive imaging modalities and offers a viable alternative for risk stratification of patients undergoing non-cardiac surgery. CRD42018100883.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20692
DOI: 10.1136/heartjnl-2018-314649
ORCID: 0000-0002-8741-8631
0000-0003-3206-5725
PubMed URL: 31018953
Type: Journal Article
Subjects: CT
coronary angiography
non-cardiac surgery
postoperative complications
preoperative
Appears in Collections:Journal articles

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