Trevethan-Cravioto Sergio, Cossío-Aranda Jorge, Martínez-Ríos Marco A, Arias-González José A, Vallejo Enrique, Meave Aloha, Kimura-Hayama Eric
Departamento de Consulta Externa. Instituto Nacional de Cardiología Ignacio Chávez. México D.F., México.
Arch Cardiol Mex. 2011 Apr-Jun;81(2):75-81.
Significant Coronary Artery Disease (CAD>50%) it can easily detected with Multislice Computed Tomography (MSCT), nevertheless if MSCT may replace Invasive Coronary Angiography (ICA) in the preoperative assessment of the patient undergoing to non-coronary cardiac surgery is not well defined. The objective of this study was to know if the MSCT can replace ICA in the preoperative valuation of patients who go to cardiac surgery
64 consecutive patients in Class I recommendation of American College of Cardiology / American Heart Association (ACC/AHA) guidelines for preoperative ICA were evaluated. Patients with angina, contrast medium allergy, serum creatinine up to 2.0 mg/dL, previous coronary cardiac surgery or coronary angioplasty and supraventricular arrhythmias were excluded. Both, Coronary artery calcium (CAC) and coronary angiography were evaluated.
The prevalence of significant (>50%) CAD was 12.5%. The Sensitivity of MSCT to detect significant CAD was 87.5%, its Specificity of 92.8%, Predictive Negative Value was 98.1% and Area Under the Curve (ROC analysis) = 0.90. Anyone with Rheumatic Valvular Disease had significant CAD or CAC>400 UA (RR = 0.80, IC95% 0.69-0.94). Degenerative Aortic Valve Stenosis had a major probability of significant CAD (RR of 9.0; IC 95% 1.64-49.80). Logistic Regression Analysis showed than CAC>400 UA (Coef β 0,351, t = 4.402 p = 0.000) and male gender (Coef β 0,179, t = 2.445, p = 0.017), were the best predicting variables of CAD. This study shows different populations in patients undergoing to non-coronary cardiac surgery.
Gender, CAC> 400 UA and type of cardiac disease previously surgery may be useful for triage to MSCT or ICA in the preoperative assessment. This study shows that ICA may be necessarily indicated in some patients in assessment of non-coronary cardiac surgery but not absolutely indicated in all patients that Guidelines of ACC/AHA have recommended.
严重冠状动脉疾病（CAD>50%）可通过多层螺旋计算机断层扫描（MSCT）轻松检测出来，然而MSCT是否能在接受非冠状动脉心脏手术患者的术前评估中取代有创冠状动脉造影（ICA），目前尚无明确结论。本研究的目的是了解MSCT在接受心脏手术患者的术前评估中是否能取代ICA。
对64例符合美国心脏病学会/美国心脏协会（ACC/AHA）术前ICA指南I类推荐的连续患者进行评估。排除有胸痛、造影剂过敏、血清肌酐高达2.0mg/dL、既往有冠状动脉心脏手术或冠状动脉成形术以及室上性心律失常的患者。同时评估冠状动脉钙化（CAC）和冠状动脉造影。
严重（>50%）CAD的患病率为12.5%。MSCT检测严重CAD的敏感性为87.5%，特异性为92.8%，阴性预测值为98.1%，曲线下面积（ROC分析）=0.90。任何患有风湿性瓣膜病的患者均有严重CAD或CAC>400 UA（RR = 0.80，95%CI 0.69 - 0.94）。退行性主动脉瓣狭窄患者发生严重CAD的可能性更大（RR为9.0；95%CI 1.64 - 49.80）。逻辑回归分析显示，CAC>400 UA（系数β0.351，t = 4.402，p = 0.000）和男性（系数β0.179，t = 2.445，p = 0.017）是CAD的最佳预测变量。本研究显示了接受非冠状动脉心脏手术患者的不同人群。
性别、CAC>400 UA以及既往手术的心脏病类型可能有助于在术前评估中对MSCT或ICA进行分类。本研究表明，在评估非冠状动脉心脏手术时，ICA可能有必要用于某些患者，但并非ACC/AHA指南推荐的所有患者都绝对需要。
