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Published on: August 28, 2018
CCTA and CACS for preoperative cardiovascular risk stratification in patients undergoing noncardiac surgery: A
Ioannis Kyriakoulis1, Konstantinos G Kyriakoulis2, Konstantinos Aznaouridis3
1Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Insights
Coronary Computed Tomography Angiography (CCTA) and Coronary Artery Calcium Score (CACS) effectively predict Major Adverse Cardiovascular Events (MACE) after noncardiac surgery. These imaging techniques reliably risk stratify patients, improving preoperative assessment and outcomes.
Area of Science:
- Cardiology
- Radiology
- Cardiovascular Imaging
Background:
- Major Adverse Cardiovascular Events (MACE) are significant causes of morbidity and mortality after noncardiac surgery.
- Traditional preoperative cardiovascular risk stratification relies on myocardial perfusion imaging or stress echocardiography.
- Coronary Computed Tomography Angiography (CCTA) and Coronary Artery Calcium Score (CACS) show prognostic value for MACE prediction.
Purpose of the Study:
- To systematically evaluate the prognostic value of CCTA and CACS in predicting short- and long-term MACE in patients undergoing noncardiac surgery.
- To assess the diagnostic performance of CCTA and CACS for MACE prediction.
- To compare the effectiveness of CCTA and CACS in cardiovascular risk stratification.
Main Methods:
- Systematic literature search in MEDLINE and Scopus for relevant studies.
- Meta-analysis using a random-effect model to estimate pooled Odds Ratios for MACE.
- Bivariate random-effects meta-analysis to assess pooled sensitivity and specificity; meta-analyses of proportions for PPV, NPV, and accuracy.
Main Results:
- Fourteen studies included in the meta-analysis.
- Obstructive stenosis (≥50%) on CCTA significantly increased MACE odds (short-term OR: 3.94, long-term OR: 8.95).
- Severe CACS (≥400) also increased MACE odds (short-term OR: 2.29, long-term OR: 5.45).
- CCTA and CACS demonstrated high Negative Predictive Value (NPV) but moderate Positive Predictive Value (PPV).
Conclusions:
- Obstructive stenosis on CCTA reliably risk stratifies patients for MACE.
- Severe CACS (≥400) is also a reliable indicator for risk stratification in noncardiac surgery patients.
- CCTA and CACS are valuable tools for preoperative cardiovascular risk assessment.
Background:
Major Adverse Cardiovascular Events (MACE) is a common cause of perioperative and long-term morbidity and mortality following noncardiac surgery. Patients who require preoperative cardiovascular risk stratification, traditionally undergo noninvasive cardiac imaging using myocardial perfusion imaging or stress echocardiography. Coronary Computed Tomography Angiography (CCTA) and Coronary Artery Calcium Score (CACS) have demonstrated prognostic value in predicting postoperative MACE and effectively risk stratifying patients undergoing noncardiac surgery.
Methods:
We performed a systematic search in MEDLINE and Scopus for studies reporting data on preoperative CCTA and CACS results and postoperative short- and long-term MACE in patients undergoing noncardiac surgery. A random-effect model (DerSimonian-Laird approach) was used to estimate the pooled Odds Ratios for MACE according to different CCTA and CACS results. A bivariate random-effects meta-analysis model was employed to assess pooled sensitivity and specificity of CCTA and CACS for MACE, and meta-analyses of proportions were performed to assess pooled positive predictive value (PPV), negative predictive value (NPV), and accuracy estimates.
Results:
Out of 1,009 studies identified from the literature search, fourteen studies were included in the meta-analysis. Obstructive stenosis (stenosis ≥50 %) on CCTA demonstrated increased odds for MACE compared to nonobstructive stenosis or normal findings, both in short- and long-term postoperative period (OR: 3.94, 95 % CI: 1.63-9.54 and OR: 8.95, 95 % CI: 4.48-17.87, respectively). Similar outcomes were observed when comparing patients with severe CACS (CACS ≥400) (OR: 2.29, 95 % CI: 1.35-3.86 and OR: 5.45, 95 % CI: 3.49-8.51 for short- and long-term postoperative MACE, respectively). In terms of prognostic performance CCTA and CACS demonstrated high NPV but moderate PPV for short- and long-term postoperative MACE.
Conclusion:
Obstructive stenosis on CCTA as well as severe CACS (CACS ≥400) can reliably risk stratify patients undergoing noncardiac surgery.
Protocol Registration:
CRD42024600216.
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