THE ROLE OF CT CORONARY ANGIOGRAPHY IN RISK DETERMINATION OF MAJOR
CARDIAC EVENTS IN PATIENTS PRIOR TO NON-CARDIAC SURGICAL INTERVENTIONS
Voronova I.G.1,2, Zyablova E.I.1,2
1 - Scientific Research Institute, Ochapovsky Regional Clinical Hospital No.1.
2 - Kuban State Medical University, Krasnodar, Russia.
|
T |
his literature review is devoted to computed tomography (CT) of the coronary arteries in patients with non-coronary pathology prior to non-cardiac surgery.
Material and methods. We review scientific publications on the role of CT coronary angiography in the diagnosis of coronary arteries atherosclerosis in patients with non-cardiac surgical interventions. Both multicenter prospective randomized studies and single-center non-randomized studies are reviewed.
Results. The sensitivity and specificity of CT angiography for detecting hemodynamically significant coronary artery stenoses (more than 50%) according to studies by different authors (compared to invasive coronary angiography) is very high (sensitivity ranges from 83 to 100%, specificity from 75% to 97%). For example, in a meta-analysis by Koshy et al., the risk of perioperative adverse cardiovascular events was higher in patients with widespread and severe coronary artery calcification on CT coronary angiography, with multivessel disease (more than 2 coronary arteries) representing the greatest risk for patients.
Discussion. Serious adverse cardiovascular events occurring after non-cardiac surgery are usually related to pre-existing coronary artery disease. Assessing the risk of perioperative adverse cardiovascular events is essential for surgical planning. CT coronary angiography is a non-invasive test for detecting or excluding coronary heart disease with high sensitivity and specificity. Although current guidelines do not include CT coronary angiography as a routine preoperative test for patients undergoing non-cardiac surgery, it is increasingly being used in clinical practice for preoperative testing to diagnose coronary artery disease.
Conclusion. In a pooled analysis by Koshy et al, coronary calcification >1000 and multivessel disease were associated with the highest perioperative risk of adverse cardiovascular events (OR 10.4; 95% CI; p < 0.01). Therefore, CT coronary angiography in patients with non-coronary pathology in the preoperative period is of particular interest as an accurate diagnostic method for identifying atherosclerotic lesions of the coronary arteries with subsequent decision-making on a patient management.
Keywords: CT coronary angiography, coronary arteries, atherosclerosis.
Corresponding author: Voronova I.G., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Voronova I.G., Zyablova E.I. The role of CT coronary angiography in risk determination of major cardiac events in patients prior to non-cardiac surgical interventions. REJR 2025; 15(4):194-207. DOI: 10.21569/2222-7415-2025-15-4-194-207.
Received: 14.11.24 Accepted: 19.12.25