Coronary Artery Plaque Burden and Perioperative Cardiac Risk

Mahla, Elisabeth; Vicenzi, Martin N.; Schröttner, B.; Maier, Robert; Tiesenhausen, Kurt; Watzinger, Norbert; Rienmüller, R.; Moser, Rita L.; Metzler, H.

doi:10.1097/00000542-200111000-00017

Cited by 8 publications

(2 citation statements)

References 22 publications

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“…Previous studies demonstrate that CAC from ECGgated CT imaging before noncardiac surgery is associated with perioperative cardiovascular events. [8][9][10][11] In a single-center study of 239 patients undergoing preoperative ECG-gated chest CT imaging, patients with CAC scores ≥113 were 4-fold more likely to experience 30-day postoperative cardiovascular events than patients with lower scores. 8 Previous studies also report strong agreement between CAC scores derived from non-ECG-gated versus ECG-gated CT imaging, 17 with extensive data reported from low-dose CT imaging from COPD databases and lung cancer screening trials.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] CAC scores measured from ECG-gated CT scans before noncardiac surgery have also been shown to independently predict perioperative cardiovascular events. [8][9][10][11] However, the effect of this observation has been limited, because at the time of preoperative evaluation, results of a CT coronary angiography or ECG-gated CAC score are not commonly available.…”

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confidence: 99%

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Existing Nongated CT Coronary Calcium Predicts Operative Risk in Patients Undergoing Noncardiac Surgeries (ENCORES)

Choi,

Hayes,

Maidman

et al. 2023

Circulation

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BACKGROUND: Preoperative cardiovascular risk stratification before noncardiac surgery is a common clinical challenge. Coronary artery calcium scores from ECG-gated chest computed tomography (CT) imaging are associated with perioperative events. At the time of preoperative evaluation, many patients will not have had ECG-gated CT imaging, but will have had nongated chest CT studies performed for a variety of noncardiac indications. We evaluated relationships between coronary calcium severity estimated from previous nongated chest CT imaging and perioperative major clinical events (MCE) after noncardiac surgery. METHODS: We retrospectively identified consecutive adults age ≥45 years who underwent in-hospital, major nongated surgery from 2016 to 2020 at a large academic health system composed of 4 acute care centers. All patients had nongated (contrast or noncontrast) chest CT imaging performed within 1 year before surgery. Coronary calcium in each vessel was retrospectively graded from absent to severe using a 0 to 3 scale (absent, mild, moderate, severe) by physicians blinded to clinical data. The estimated coronary calcium burden (ECCB) was computed as the sum of scores for each coronary artery (0 to 9 scale). A Revised Cardiac Risk Index was calculated for each patient. Perioperative MCE was defined as all-cause death or myocardial infarction within 30 days of surgery. RESULTS: A total of 2554 patients (median age, 68 years; 49.7% women; median Revised Cardiac Risk Index, 1) were included. The median time interval from nongated chest CT imaging to nongated surgery was 15 days (interquartile range, 3–106 days). The median ECCB was 1 (interquartile range, 0–3). Perioperative MCE occurred in 136 (5.2%) patients. Higher ECCB values were associated with stepwise increases in perioperative MCE (0: 2.9%, 1–2: 3.7%, 3–5: 8.0%; 6–9: 12.6%, P <0.001). Addition of ECCB to a model with the Revised Cardiac Risk Index improved the C-statistic for MCE (from 0.675 to 0.712, P =0.018), with a net reclassification improvement of 0.428 (95% CI, 0.254–0.601, P <0.0001). An ECCB ≥3 was associated with 2-fold higher adjusted odds of MCE versus an ECCB <3 (adjusted odds ratio, 2.11 [95% CI, 1.42–3.12]). CONCLUSIONS: Prevalence and severity of coronary calcium obtained from existing nongated chest CT imaging improve preoperative clinical risk stratification before nongated surgery.

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