Impact of coronary computed tomography angiography (CCTA) in risk assessment of peri-operative myocardial ischemia for patients undergoing vascular surgery

Background It is recommended to perform a functional test (FT) or a coronary angiography (CA) in patients elected for vascular surgery, to predict peri-operative risk of myocardial ischemia. CCTA has proved its benefit for coronary artery disease rule out in case of chest pain and stable angina. However, its effectiveness has never been evaluated in patients’ candidates for vascular surgery. Purpose Compare CCTA, FT and CA for risk assessment of peri-operative myocardial ischemia of patients undergoing vascular surgery. Methods Patients referred for vascular surgery between November 2017 and January 2019 were prospectively included. Three groups were defined according to the pre-operative test performed: FT, CCTA or CA. A CCTA or a CA were considered positive when at least one coronary lesion u003e 50% was detected. A systematic postoperative troponin assay was performed and considered significant if u003e 5 N. The primary end point was the comparison of troponin value following vascular surgery according to the pre-operative test performed. The secondary end point was the evaluation of the accuracy of CCTA and FT to detect significant coronary lesions in comparison with CA. Results A total of 172 patients were included: 60 patients in the FT group of which 38 were negative, 59 patients in the CCTA group of which 37 were negative and 53 patients in the CA group of which 18 were negative. Rates of post-operative troponin elevation was significantly lower in the negative CCTA group than in the negative FT group (1(3%) vs. 10 (26%), P = 0,007) but similar to that in the negative CA group (vs. 1(6%)). A total of 4 (22%) patients with positive CCTA had a negative CA and 8 (24%) of positive FT had a negative CA. Conclusion CCTA could be a non-invasive alternative to pre-operative CA in patient referred for vascular surgery with better diagnostic performance than FT for rule out coronary lesion at risk of ischemia. However, CCTA should be reserved to selected patients.