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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Does preoperative screening with computed tomography of the chest decrease risk of stroke in patients undergoing
Turki B Albacker1, Abdulaziz M Alhothali1, Majid Alhomeidan2
1Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Insights
Routine chest CT scans can identify aortic calcification, a risk factor for stroke after coronary artery bypass grafting (CABG). However, this study found that a history of stroke or TIA was the only significant predictor of postoperative stroke.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Radiology
Background:
- Coronary artery bypass grafting (CABG) carries a risk of embolic stroke, often linked to aortic calcifications.
- Aortic calcification is a common source of emboli causing stroke post-CABG.
- Identifying pre-operative risk factors for stroke is crucial in CABG patients.
Purpose of the Study:
- To evaluate the clinical utility of routine preoperative chest computed tomography (CT) for screening aortic calcification.
- To determine the impact of aortic calcification screening on the incidence of postoperative stroke in CABG patients.
Main Methods:
- Retrospective case-control study of 405 patients undergoing primary isolated CABG.
- Preoperative plain chest CT used to screen for aortic calcification, categorized by location and pattern.
- Comparison of aortic calcification distribution between patients with and without postoperative stroke.
- Univariate and multivariate regression analysis to identify stroke predictors.
Main Results:
- Postoperative stroke occurred in 3.5% of patients.
- A history of preoperative stroke or transient ischemic attack (TIA) was the sole significant predictor of postoperative stroke (P<0.001).
- While higher in stroke patients, aortic calcification (aortic root, ascending, descending) did not reach statistical significance as a predictor.
Conclusions:
- Preoperative chest CT effectively detects aortic calcification in CABG patients.
- The routine use of chest CT for aortic calcification screening did not demonstrate a significant impact on preventing postoperative stroke in this study.
- Further prospective studies are needed to investigate the impact of aortic calcification screening on stroke prevention.
Background:
Stroke is one of the most feared complications post coronary artery bypass with aortic calcifications being the commonest source of embolic stroke. The aim of our study was to determine the clinical impact and usefulness of routine use of plain chest computerised tomography to screen for aortic calcification on incidence of postoperative stroke in coronary artery bypass grafting (CABG) patients.
Methods:
This is a retrospective case-control study that included four hundred and five patients who underwent primary isolated CABG and had preoperative plain chest computerised tomography as a screening for aortic calcification. Aortic calcification was classified according to the area involved (ascending, arch, arch vessels and descending aorta) and the pattern of calcification. Patients were divided into two groups according to the incidence of postoperative stroke and the aortic calcification distribution was compared between the two groups. Stroke predictors were studies using univariate and multivariate regression analysis.
Results:
Fourteen patients (3.5%) developed postoperative stroke. There was no difference in preoperative and operative characteristics between patients who developed postoperative stroke and those who did not, except for the history of preoperative stroke or transient ischemic attack (TIA) that was higher in the group who developed postoperative stroke (50.00% vs. 6.19%, P<0.001). Patients who developed postoperative stroke had higher percentage of aortic root calcification (78.57% vs. 64.18%), ascending aortic calcification (28.57% vs. 19.07%) and descending aortic calcification (85.71% vs. 73.71%) but none of them reached statistical significance. History of preoperative stroke or TIA was the only significant predictor of postoperative stroke using both univariate and multivariate regression models.
Conclusions:
Our study showed the importance of preoperative computed tomography (CT) scan of the chest as a screening tool as it detected a high prevalence of aortic calcification in our patients. However, its impact on prevention of postoperative stroke needs to be investigated further in future prospective studies.
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