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Coronary artery calcification at CT as a predictor for cardiac complications of thoracic surgery
1Department of Pulmonary Medicine, Madigan Army Medical Center, Tacoma, Washington 98431-5000, USA.
Insights
Coronary artery calcification (CAC) on preoperative CT scans predicts cardiac complications in noncardiac thoracic surgery. Absence of CAC reliably indicates a safe postoperative cardiac outcome.
Area of Science:
- Cardiology
- Radiology
- Thoracic Surgery
Background:
- Noncardiac thoracic surgery poses risks for cardiac complications.
- Preoperative risk stratification is crucial for patient management.
Purpose of the Study:
- To assess the predictive value of coronary artery calcification (CAC) detected on preoperative computed tomography (CT) scans of the thorax for subsequent cardiac complications.
- To evaluate the association between CAC and adverse cardiac events following noncardiac thoracic surgery.
Main Methods:
- Retrospective review of 75 patients who underwent noncardiac thoracic surgery.
- Analysis of inpatient records for postoperative cardiac complications (arrhythmia, hypotension, myocardial infarction, heart failure, stroke, death).
- Independent assessment of coronary artery calcification (CAC) extent on preoperative CT scans.
Main Results:
- Six out of 75 patients experienced cardiac complications, including one death.
- A coronary artery calcification (CAC) score of 7 or higher was present in 39 patients.
- The sensitivity and negative predictive value of CAC score >= 7 for cardiac complications were 100%, while specificity was 71% and positive predictive value was 23%.
Conclusions:
- Coronary artery calcification (CAC) on preoperative CT is linked to cardiac complications in noncardiac thoracic surgery.
- While the presence of CAC has a low positive predictive value, its absence is a strong indicator of a favorable postoperative cardiac course.
Purpose:
Our goal was to determine the predictive value of coronary artery calcification (CAC) on preoperative CT of the thorax for cardiac complications of noncardiac thoracic surgery.
Method:
Of 117 patients undergoing noncardiac thoracic surgical procedures between January 1, 1993, and June 1, 1995, at our institution, 75 had inpatient records and chest CTs available for retrospective review. Inpatient records were reviewed for postoperative cardiac complications (arrhythmia, hypotension with ECG changes, myocardial infarction, congestive heart failure, stroke, and death). The CT scans were scored for the presence and extent of CAC by an independent observer.
Results:
Six of the 75 patients had cardiac complications including 1 death. Thirty-nine of the 75 patients had a CAC score of > or = 7. The sensitivity, specificity, positive predictive value, and negative predictive value of a CAC score of > or = 7 for cardiac complications were 100, 71, 23, and 100%, respectively.
Conclusion:
The presence of CAC on preoperative CT scanning is associated with cardiac complications of noncardiac thoracic surgery; however, the positive predictive value is low. The absence of CAC was a reliable predictor of a favorable postoperative cardiac course.